Making the Checklist Board Time-Out a Hospital ‘Red Rule’
“Our checklists were a hodgepodge of methods and not often used.”
Red Rules are rules that cannot be broken.
They prevent power struggles and overrule the unwritten,
‘We’ve always done it that way’, standard.
An example of a Red Rule in everyday life would be the use of seatbelts.
Although surgical Time-Outs are included in safety guidelines published by the Joint Commission and the Veterans Administration, they’re not always conducted. Each year 4000+ patients suffer the consequences of surgical teams failing to conduct a Time-Out with a quality checklist to verify:
  • Correct Patient
  • Correct Procedure
  • Correct Side/Site
  • Correct Device/Implant
  • And several more verifications
The results of failing to conduct the Time-Out are:
  • Patient Fatalities 7%
  • Patient Permanent Injuries 33%
  • Patient Temporary Injuries 59%
  • Ruined Careers, Malpractice Filings, Lost Accreditations
Even with this evidence, preventable surgical errors due to failure to conduct a surgical Time-Out with a checklist continue.
Here are a few reasons why surgical Time-Outs fail:
  1. Senior management are not involved in the implementation
  2. Poorly planned Time-Out process
  3. Poorly planned checklists
  4. Time-Out occurs before everyone is ready
  5. Time-Out occurs without full-participation
Here is an example of a best practice Time-Out:
  1. The Time-Out is a Red Rule without exceptions
  2. The checklist is well-designed and approved
  3. Time-Out Team Leaders are appointed
  4. The Time-Out begins when everyone is ready
  5. Full-participation and silence are required
  6. Each team member announces their name and role
  7. Each checklist item is verified as correct by every member
  8. The staff are empowered to Speak-Up for an unsafe situation
  9. Case specific announcements – Team Leader signs off
The Checklist Boards Corporation of Rochester, NY has a solution.
This from Checklist Boards president, Rick Taylor:
“We listened carefully to our partner hospital’s O.R. management and developed a model Checklist Board.
Each Checklist Board is a custom design to meet our partner’s exact needs. There can be up to 25 line items, include a Count Board, and a Fire Risk notification.
We start with a solid, pure acrylic base. Next we add interactive sliders to indicate that the line item is verified as correct. The wall-mounted Checklist Boards are easily viewable from the operating room table or can be attached to a wheeled pole to be brought to the table before, during and after the procedure, as needed. “
“We’ve had the privilege to install thousands of Checklist Boards in hundreds of hospitals across the country. We are always available to help your hospital to introduce a Checklist Board Campaign. We freely share success stories from hospitals who have implemented a hospital-wide Time-Out process with a Checklist Board verification for every invasive procedure performed in both inpatient and outpatient units,”
Offered Mr. Taylor.
Adding a new process takes careful planning and involvement to be successful. Some facilities immediately embrace surgical Time-Outs and checklists. Some facilities may require instituting Red Rules. Either way your patients, staff and facility will benefit.
It’s Time for the Checklist Board Time-Out.

Contact: Rick Taylor – www.ChecklistBoards.com - 585-586-0152
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Hospitals use checklists to reduce errors