TSU
Research in Nursing Practice
Patient safety is one of the most important medical concerns in a surgical procedure. Surgical errors such as wrong side or site, wrong procedure, and/or wrong person, though occur rarely, are considered as highly devastating events. In the U.S., about 28% of procedure related adverse events were reported in three different hospitals in 2011. According to the National Patient Safety Agency, 129,419 cases of surgical errors occurred in England and Wales in 2007 (McDowell & McComb, 2014).
Surgical errors resulted in different degrees of impairment or harm. Most frequently occurring problems associated with the surgical processes include hemorrhage, postoperative infections, hematoma, accidental puncture or laceration, and mechanical problems of noncardiac devices (McDowell & McComb, 2014). These problems can increase hospital stay and cost.
PICO question for the literature review on time out process was “How does performing a "time-out" process prior to starting a surgical procedure is essential for stopping wrong-side, wrong-procedure or wrong-person surgery?”
P) For patients undergoing surgery
I) Taking preoperative time-out to increase patient safety
C) Standard Procedure
O) The effect on the rates of medical errors
In 2010, Lee worked on the efficacy of extended surgical time out process in pediatric surgery. Lee asked the surgical team members to implement and used an extended surgical time out. He found that the extended surgical time out helped in improving the confidence of the operation room staff due to improved communication (Lee, 2010). Extended surgical time out process not only improved communication, but also did not disturb the workflow.
In a systematic review, investigators worked on the published literature considering the use of Safety Checklists. They found that almost 50% of the surgical complications could be prevented (McDowell & McComb, 2014). Studies showed that preprocedural surgical safety checklist could help in dealing with surgical complication rates. Improvements could be made with team discussions and overall communication.
In a study, McLaughlin and collaborators provided an online questionnaire to the members of the neurosurgical procedures in an operating room of the Ronald Reagan UCLA Medical Center (2014). 128 members of the study were asked about their perception about the time out process. 99% of the participants reported that time out process before incision helps in improving the patient safety. The study by McLaughlin et al., (2014) was an online survey that can impact the authenticity of the study as compared to face-to-face survey.
In a cross-sectional study on 427 participants including anesthetists, surgeons, nurse anesthetists, and nurses, a questionnaire was provided to them. The questionnaire was about the experience of team members about the time out process. Almost 91% of the participants of the study supported the use of time out process for correct site, patient, and procedure (Haugen et al., 2013). The study by Haugen et al., (2013) was a survey on the basis of memory that can result in biased results.
In a study, researchers conducted a multicenter prospective study, and used an observational instrument referred to as “Checklist Usability Tool”. They found that over 40% of cases lack team members, and in more than 70% of cases, team members failed to focus on the checklist. Over 39% of cases lack completion of sign out process (Russ et al., 2015). Russ et al., (2015) used more statistical analysis, so their study can be considered to provide more valid results.
In 2015, researchers studied the efficacy of aviation-style teamwork training to improve the clinical outcomes of the procedure. They studied three operating theatres in UK, and studied 72 operations. Time out procedures significantly improved after training. Moreover, teamwork training can also improve non-technical skills (Morgan et al., 2015). This Discovery Research or Literature Review is first step of ACE Star Model. It is also covering the second step in ACE Star Model in which collected knowledge is summarized for utilization.
The results of almost all the studies are consistent, and showed that the time out process could help in improving the surgical errors. In a recent review published in the journal Frontier in Pediatrics, Corbally (2014) also noted that time out process or surgical pause including parental involvement along with team-based responsibilities and team briefings could help in reducing surgical errors.
Time out process is an essential process in which operating staff take a break, collaborate with each, and communicate the appropriate steps in the surgery. This can help in reducing surgical errors including wrong site, wrong person, and wrong procedure. It is 3rd step of Translation of studies to Guidelines. After third step in ACE Star Model, the process of “Practice Integration” comes that refers to the integration of knowledge in practice, and studying the factors that would affect the implementation of time out process in decreasing surgical errors. Finally, in the fifth step, “Process, Outcome evaluation” comes, in which the evaluation of the achieved knowledge and its integration into practice is done. This is done by further studies that can be conducted by comparing the use of time out process in different specialties and nations.
References
Corbally, M. T. (2014). Can we improve patient safety? Frontiers in Pediatrics, 2, 98. doi: 10.3389/fped.2014.00098
Haugen, A. S., Murugesh, S., Haaverstad, R., Eide, G. E., & Softeland, E. (2013). A survey of surgical team members' perceptions of near misses and attitudes towards Time Out protocols. BMC Surgery, 13, 46. doi: 10.1186/1471-2482-13-46
Lee, S. L. (2010). The extended surgical time-out: does it improve quality and prevent wrong-site surgery? The Permanente Journal, 14(1), 19-23.
McDowell, D. S., & McComb, S. A. (2014). Safety checklist briefings: a systematic review of the literature. AORN Journal, 99(1), 125-137 e113. doi: 10.1016/j.aorn.2013.11.015
McLaughlin, N., Winograd, D., Chung, H. R., Van de Wiele, B., & Martin, N. A. (2014). Impact of the time-out process on safety attitude in a tertiary neurosurgical department. World Neurosurg, 82(5), 567-574. doi: 10.1016/j.wneu.2013.07.074
Morgan, L., Hadi, M., Pickering, S., Robertson, E., Griffin, D., Collins, G., . . . New, S. (2015). The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study. BMJ Open, 5(4), e006216. doi: 10.1136/bmjopen-2014-006216
Russ, S., Rout, S., Caris, J., Mansell, J., Davies, R., Mayer, E., . . . Sevdalis, N. (2015). Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study. Journal of the American College of Surgeons, 220(1), 1-11 e14. doi: 10.1016/j.jamcollsurg.2014.09.021
