The Team Time-Out, are we maximising its potential?
Jun 01, 2024
[3min read]
For anyone working in a theatre environment, the importance of the Team Time-Out (TTO) is well understood. But are we utilising it to its full potential?
When someone says, "let's do a time-out," whether it's the surgeon, circulating nurse, or you, it's easy to switch to auto-pilot. Someone locates the wristband beneath the sterile drapes, shuffles through the patient's notes to find the consent form, and eventually, the patient is identified and the time-out is completed. Job done. Or is it?
In the midst of this routine, have you noticed the unidentified medical student entering the room? The pressured scrub nurse oblivious as they hurry to complete their setup? Or that no one has identified the need for mechanical VTE prophylaxis? These are common occurrences in operating theatres, with the potential to cause serious harm to patients and increased mortality rates.
Consider these three aspects to optimise your next team time-out:
1. Establish a Team Leader
The team leader role is usually given to a senior nurse, often the circulating nurse. However, anyone with the right attributes can lead in the theatre. While the surgeon or anaesthetist might be seen as the leader, a team member who understands the dynamics, nuances, and has strong rapport with the entire team is often a better fit. Leadership in the operating theatre is more than seniority or skill level; it involves patient-centered care, respect, skill, and the ability to be vocal when needed. A team leader provides consistent, recognisable, and safe flow to the operating list. They might also set the tone for the day, perhaps with a rocking playlist or a mid-morning coffee order. Allocating this role to a suitably qualified team member establishes a solid foundation for your team time-out and beyond.
2. Identify All Team Members by Name and Role
While some theatre teams excel at this, others do not. Team introductions should extend beyond the start of the list. As radiographers, theatre technicians, nursing students, tea relievers, and others enter and leave the room, identifying them by name and role is crucial. A recent study by Birnbach et al. highlighted that consultant surgeons only knew 44% of staff names in the operating room. Sharing a mental model of communication relies on team members being easily identifiable. Tools such as name whiteboards, ID badges, and named scrub hats can aid this process. Assuming someone knows another's name and role can be dangerous. A quick re-introduction of team members is safe and free. In the sea of scrubs, face masks, and scrub hats, roles can be easily misconstrued, especially with new or junior staff or during times of stress.
3. Follow Your Surgical Safety Checklist
Your organisation has invested time and resources to create your Surgical Safety Checklist document, so use it. In high-turnover operating lists or unexpected events, the Team Time-Out can often be rushed or narrated from memory. Systematically working through the checklist ensures all critical components are addressed and discussed as a team. These include, but are not limited to, two-point patient identification, checking the signed consent form, identifying team members by name and role, use of antibiotics, use of chemical and mechanical VTE prophylaxis, tourniquet use, confirming required equipment is present and functional, anticipating intra-operative and post-operative issues, and allocating a post-surgery bed if needed. A process that takes 30-60 seconds is worth every second to ensure these critical aspects are addressed as a team. Surgical Safety Checklists are generally organised into identifiable, colour-coded columns, enhancing understanding and emphasising each aspect.
Next time you lead or participate in a team time-out, ask yourself: Are we doing this just because we have to, or are we optimising it to its full potential?
Andy Goyen, RN.
References:
Birnbach, D. J., Rosen, L. F., Fitzpatrick, M., Lubarsky, D. A., & Menna, J. (2017). The Use of Names in the Operating Room: A Study on Team Familiarity. Anesthesiology, 99(3), 430-434.
World Health Organization. (2009). Surgical Safety Checklist. Retrieved from https://www.who.int/patientsafety/safesurgery/checklist/en/
