Eight seconds are on the clock. The team down by one point calls a timeout, discusses a plan and gets everyone on the same page so everyone knows what to do. Without the timeout, the team could lose the game.
Surgery is no game, yet surgical teams at Yampa Valley Medical Center always take a formal "timeout" before they begin operating. It's an opportunity for the entire team, including surgeons, nurses and surgical technologists to pause before the procedure. During the timeout, they communicate as a group and confirm key information about the patient and procedure to prevent errors from occurring.
Wednesday is National Time Out Day, recognized by the Association of Perioperative Registered Nurses, the Council on Surgical and Perioperative Safety and The Joint Commission.
Its purpose is to create public awareness of the measures hospitals take to prevent surgical errors. The formal timeout is part of the Joint Commission's "Universal Protocol for preventing Wrong Site, Wrong Procedure, Wrong Person Surgery."
YVMC patients participate in several steps of these guidelines by answering questions on the day of their surgery.
"We always tell the patients that they will be asked the same questions over and over again," YVMC Surgical Services Nurse Manager Karla Weeks said. "It's for their own safety."
Patients are asked to give two forms of identification: their name and their birth date. They also are asked to state the type of operation and verify the location or site of the procedure. Pediatric patients and those who are unable to communicate information for themselves will require a legal guardian to speak on their behalf.
"We ask the patient or guardian to verbally and physically show the team exactly where they are having surgery," Weeks said. "Once the patient identifies the correct site and side of the body, the surgeon will use a permanent marker to mark the location with his or her initials."
Before the patient is transferred from YVMC's pre-operative area to the operating room, registered nurses from Day Surgery and the OR will complete a checklist to ensure all steps were taken during the verification process. This also includes a visual inspection of the surgical site and verbal confirmation from the patient.
"Once inside the OR and prior to any anesthesia or surgical care, an RN will confirm the patient's identity, consent, operative procedure, side and site," Weeks said. "With every member of the surgical team present, the surgeon will initiate the timeout for final verification."
The YVMC surgeon will state the patient's name, site and side, and correct position for that particular operation. If an implant such as an artificial hip is to be placed, the availability of the correct implant is confirmed.
Finally, the surgeon will ask, "Are we all in agreement?" Each member of the surgical team will verbally respond. An RN will confirm that the surgical timeout matches the patient's consent form.
Although Weeks is not aware of YVMC ever having discovered a discrepancy during the timeout, she said if it did happen the team would stop everything. They would obtain the patient's history and physical examination from the primary care physician and verify the procedure with the family.
Weeks sees no reason why a nurse or surgical technologist would be reluctant to speak up during the timeout at YVMC.
"This hospital is unique," she said. "Here we have much more of a team atmosphere with all members feeling comfortable speaking up for the patient."
Prior to coming to YVMC, and before Universal Protocol was established or timeouts were taken, Weeks caught a wrong-site surgery just before it occurred.
The patient arrived in the OR without having been questioned by Weeks, who was the OR nurse. The patient complained, "My right knee is killing me," and the surgeon prepared the right knee for surgery.
However, Weeks had a funny feeling and checked the patient's chart. Although the patient had issues with both knees, it was the left knee that was scheduled for surgery on that day. Weeks spoke up before the incision was made and prevented the mistake.
Timeouts play a vital role in surgical teams' ability to provide safe, personalized and quality care to their patients at YVMC.
Riley Polumbus is communications specialist at Yampa Valley Medical Center.