2 Minutes Saved, $250,000 - Justification for the Checklist Board Surgical Time-Out
“We see it happen again and again. We seem to be failing in this area,” said Dr. George Thomas at a recent Medical Board Hearing.
He was referring to the incidence of preventable surgical errors of wrong patient, wrong procedure, wrong site, and retained items.
The Joint Commission for Hospital Accreditation and the Veterans Administration produced guidelines to prevent surgical errors of omission, commission and misidentification.
The guidelines are thorough but of little value if not followed.
Since the mid 1930s the aviation industry has embraced the use of Time-Out Checklists. Checklists are used before, during and after flights. The resulting safety record of the aviation industry is extraordinary. This success hasn’t been realized in the medical industry.
Here are a few examples of why surgical Time-Outs fail:
Management is not engaged in the implementation
Staff are not empowered to escalate a failure to Time-Out
Poorly planned Time-Out process
Poorly planned checklist
The Time-Out occurs before everyone is ready
The Time-Out occurs without full participation
A non-retribution policy is not in effect
No Time-Out Team Leader assigned
No patient safety focused culture in the O.R.
Here is an example of a well-planned Time-Out with Checklist Board:
Time-Out begins when everyone is ready – no rushing
The Time-Out Team Leader calls for everyone’s attention
Full-participation and silence are required
Each team member announces their name and role
Each item on the Checklist Board is verified as complete/correct
Each team member is encouraged to Speak-Up for safety
Case specific announcements, Team Leader chart sign-off
The Checklist Board Corporation of Rochester, NY has a solution.
“We developed a professional, durable and fast checklist,” said Rick Taylor president of Checklist Boards.
Even with a large 20-item checklist the process should take about 2 minutes. If any item is not complete or correct the process should stop and then restarted from the beginning.
This final check can catch potential errors that were not caught during the complex perioperative phase.
Not performing a Checklist Board can lead to injuries and worse.
Here is an example of costs associated with a Failure to Time-Out that resulted in a wrong side hip arthroscopy procedure.
Negative press, negative social media posts, unexpected TJC survey, unexpected state and county health department surveys, increased employee turnover, patient, family and friends retell the story for years, defend and settle multiple lawsuits - $205,300.
This single event cost the hospital 500 times the cost of a Time-Out Checklist Board. The 2-minutes saved by not doing the Time-Out cannot be justified as a cost-savings or efficiency improvement. The incidence of these preventable surgical errors remain high:
Wrong Procedure – 1000+ times per year
Wrong Side/Site – 1000+ times per year
Retained Items – 2000+ times per year
The Checklist Boards Corporation is always available to help you introduce a Time-Out Campaign at your hospital or clinic. We’ve had the privilege to install thousands of Checklist Boards in hundreds of hospitals,” added Mr. Taylor.
We freely share success stories from hospitals that successfully implemented a Checklist Board Time-Out.