The second “time-out”: a surgical safety checklist for lengthy robotic surgeries

Abstract

Robotic surgeries of long duration are associated with both increased risks to patients as well as distinct challenges for care providers. We propose a surgical checklist, to be completed during a second “time-out”, aimed at reducing peri-operative complications and addressing obstacles presented by lengthy robotic surgeries. A review of the literature was performed to identify the most common complications of robotic surgeries with extended operative times. A surgical checklist was developed with the goal of addressing these issues and maximizing patient safety. Extended operative times during robotic surgery increase patient risk for position-related complications and other adverse events. These cases also raise concerns for surgical, anesthesia, and nursing staff which are less common in shorter, non-robotic operations. Key elements of the checklist were designed to coordinate operative staff in verifying patient safety while addressing the unique concerns within each specialty. As robotic surgery is increasingly utilized, operations with long surgical times may become more common due to increased case complexity and surgeons overcoming the learning curve. A standardized surgical checklist, conducted three to four hours after the start of surgery, may enhance perioperative patient safety and quality of care.

Nursing performance in robotic surgeries: integrative review

“…Aiming at patient safety in robotic surgeries, it is important to use the checklist to reduce errors. Long robotic surgeries are associated to increased risks for patients, and the extended time during the surgery increases the risk of the patient for position-related complications and other adverse events, so that it is necessary to use and standardize a surgical checklist to improve patient safety and quality of care (24) .…”

“…Articles A5, A6 and A9 address the need for surgical counting of gauzes, compresses and instruments in order to maintain surgical safety by preventing inadvertent retention of compresses or instruments in surgical wounds (19,21,24) .…”

Back to Basics: Preventing Perioperative Pressure Injuries

“…Perioperative nurses should always be mindful of the amount of time that the patient has spent in the OR, because the prevalence of pressure injuries is reported to be 8.5% or higher in patients who have been in surgeries lasting more than three hours 11 . Song et al 17 developed a checklist as a second time out during prolonged robotics procedures. This time out gives the entire team a chance to evaluate the progression of the surgery, identify potential risks to the patient, discuss what factors are contributing to the extended OR time, and identify strategies such as repositioning and checking the skin for signs of injury 17 .…”

10 Years In, Why Time Out Still Matters

“…Surgical teams routinely perform the time out before the incision; however, some surgical teams have begun using an extended, or double, time‐out process during preinduction while the patient is awake and with all team members present and again postinduction before the surgical phase begins with all team members present. The two additional checks of an extended time out have been shown to address patient safety concerns related to extended operative times during robotic surgery 31 …”