Improving Preprocedure Time Out Compliance Using Remote Audiovisual Observation

Abstract

Health care organization leaders can help prevent surgical errors by ensuring compliance with standardized preprocedure time outs that require the active participation and engagement of the entire surgical team. Some surgical department leaders have used remote video observation without audio to monitor compliance with the time out. After a sentinel event occurred, leaders at our large academic medical center initiated a quality improvement project to audit compliance with the standardized preprocedure time out. We used remote audiovisual observation to ensure that all members of the procedure team were adhering strictly to the elements of the preprocedure time out in all invasive procedure areas. Since the beginning of this remote auditing process, team member compliance with the standardized preprocedure time out has improved.

Standardization and Visualization of the Surgical Time-Out

“…However, audits 4 years later reveal a drift to only 53% to 62% completion of a full TO process within their health system 15 . This drift is not uncommon, in New York City; a root cause analysis for a sentinel event in 2014, after their health systems adoption of a TO process, revealed team members leading the TO from memory led to omission of required elements and disengagement from team members 20 . As in our study, individual team members practice dictated the included elements of the TO, none of which were standardized across procedures or staff members.…”

“…15 This drift is not uncommon, in New York City; a root cause analysis for a sentinel event in 2014, after their health systems adoption of a TO process, revealed team members leading the TO from memory led to omission of required elements and disengagement from team members. 20 As in our study, individual team members practice dictated the included elements of the TO, none of which were standardized across procedures or staff members. This led to significant drift from national directives and required TO elements, where 0% of TOs discussed 100% of the desired and required topics.…”

“…8,[16][17][18][19] Quality improvement initiatives based on these pillars of implementation have shown success in improving a subset of these barriers. 20,21 LEAN production methodology in healthcare has been used as a framework for quality improvement project development and implementation strategies. [22][23][24][25] Key principles of LEAN production include continuous improvement and standardization.…”

“…Given these barriers, TO implementation has potential areas for improvement including compliance, standardization, engagement, and effectiveness 8,16–19 . Quality improvement initiatives based on these pillars of implementation have shown success in improving a subset of these barriers 20,21 …”