Skip to main content
Book cover

The SAGES Manual of Quality, Outcomes and Patient Safety pp 419–441Cite as

Checklists, Surgical Timeout, Briefing, and Debriefing: Safety in the Operating Room

  • 141 Accesses

Abstract

Operating rooms consist of high-stress, complex environments, which creates a propensity for serious errors. In order to improve patient safety, several strategies can be implemented. By executing a timeout before and after the planned procedure, one can significantly decrease the number of wrong site surgeries and retained foreign bodies. In addition, checklists help remind a team of people of the minimum, routine steps required and can help close the loop in communication and verify that pivotal jobs have indeed been completed. Briefing and debriefing can also help to improve the communication of the surgical team by setting expectations and verifying that everyone understands the planned strategy for the day. This small investment of time and energy has the potential to prevent devastating complications.

Keywords

  • Surgical timeout
  • Briefing
  • Debriefing
  • Surgical checklist
  • Patient safety

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-94610-4_22
  • Chapter length: 23 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   89.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-94610-4
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   119.99
Price excludes VAT (USA)
Learn about institutional subscriptions
Figure 22.1
Figure 22.2

References

  1. Centers for Disease Control and Prevention. FastStats - Physician Office Visits. Centers for Disease Control and Prevention, 10 Oct 2019. www.cdc.gov/nchs/fastats/physician-visits.htm.

  2. Shahbandeh M. Total number of retail prescriptions filled annually in the U.S. 2013–2025. Statista, 28 Aug 2020. www.statista.com/statistics/261303/total-number-of-retail-prescriptions-filled-annually-in-the-us/.

  3. Surgery 2015–2017 Final Report. NQF: Surgery 2015–2017 Final Report, National Quality Forum, 20 Apr 2017. www.qualityforum.org/Publications/2017/04/Surgery_2015-2017_Final_Report.aspx.

  4. Kohn LT, et al. To err is human building a safer health system. Washington D.C., USA: National Academy Press; 2000.

    Google Scholar 

  5. Krizek TJ. Surgical error: ethical issues of adverse events. Arch Surg. 2000;135(11):1359. https://doi.org/10.1001/archsurg.135.11.1359.

    CAS  CrossRef  PubMed  Google Scholar 

  6. Suliburk JW, et al. Analysis of human performance deficiencies associated with surgical adverse events. JAMA Netw Open. 2019;2(7). https://doi.org/10.1001/jamanetworkopen.2019.8067.

  7. Serious Reportable Events in Healthcare–2006 Update. NQF: Serious Reportable Events in Healthcare–2006 Update. National Quality Forum, 2007. www.qualityforum.org/Publications/2007/03/Serious_Reportable_Events_in_Healthcare%E2%80%932006_Update.aspx.

  8. Fact Sheet ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS - NEVER EVENTS. CMS.gov, Centers for Medicare and Medicaid, 18 May 2006. www.cms.gov/newsroom/fact-sheets/eliminating-serious-preventable-and-costlymedical-errors-never-events.

  9. Safe Surgery. Center for Transforming Healthcare. The Joint Commission. www.centerfortransforminghealthcare.org/improvement-topics/safe-surgery/?_ga=2.92660317.1584263004.1596126705-525192084.1596126705.

  10. Pellegrini C. Time-outs and their role in improving safety and quality in surgery. Bull Am Coll Surg. 2017. https://bulletin.facs.org/2017/06/time-outs-and-their-role-in-improving-safety-and-quality-in-surgery/.

  11. Summary Data of Sentinel Events Reviewed by the Joint Commission. The Joint Commission, The Joint Commission, 1 July 2019. www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/summary-2q-2019.pdf.

  12. Steelman VM, et al. Unintentionally retained foreign objects: a descriptive study of 308 sentinel events and contributing factors. Jt Comm J Qual Patient Saf. 2019;45(4):249–58. https://doi.org/10.1016/j.jcjq.2018.09.001.

    CrossRef  PubMed  Google Scholar 

  13. Steelman VM, et al. Retained surgical sponges: a descriptive study of 319 occurrences and contributing factors from 2012 to 2017. Patient Saf Surg. 2018;12(1) https://doi.org/10.1186/s13037-018-0166-0.

  14. Joint Commission identifies 29 main causes of wrong-site surgery, offers solutions. Becker’s ASC Review, 30 June 2011. www.beckersasc.com/asc-accreditation-and-patient-safety/joint-commission-identifies-29-main-causes-of-wrong-site-surgery-offers-solutions.html.

  15. 10 most common causes of wrong-site surgeries, according to the Joint Commission: Incidents involving wrong-patient, wrong-site or wrong-procedure errors were the sixth most common sentinel events reported to the Joint Commission last year. Becker’s Hospital Review. www.beckershospitalreview.com/quality/10-most-common-causes-of-wrong-site-surgeries-according-to-the-joint-commission.html.

  16. Göras C, et al. Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study. BMJ Open. 2019;9(5). https://doi.org/10.1136/bmjopen-2018-026410.

  17. Bretonnier M, et al. Interruptions in surgery: a comprehensive review. J Surg Res. 2020;247:190–6. https://doi.org/10.1016/j.jss.2019.10.024.

    CrossRef  PubMed  Google Scholar 

  18. Arora S, et al. The impact of stress on surgical performance: a systematic review of the literature. Surgery, 2010;147(3). https://doi.org/10.1016/j.surg.2009.10.007.

  19. Systems approach. PSNet, AHRQ, 7 Sept 2017. psnet.ahrq.gov/primer/systems-approach.

  20. VA.gov: Veterans Affairs. Ensuring Correct Surgery, 5 Dec 2013. www.patientsafety.va.gov/media/correctsurg.asp.

  21. The universal protocol for preventing wrong site, wrong procedure, and wrong person surgery. The Joint Commission, www.jointcommission.org/-/media/tjc/documents/standards/universal-protocol/up_poster1pdf.pdf.

  22. Safe Surgery. World Health Organization, World Health Organization, 13 June 2017, www.who.int/patientsafety/topics/safe-surgery/en/.

  23. “Implementation manual surgical safety checklist.” World Alliance for Patient Safety, The World Health Organization, 2008., www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Manual_finalJun08.pdf?ua=1.

  24. Haynes AB, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9. https://doi.org/10.1056/nejmsa0810119.

    CAS  CrossRef  PubMed  Google Scholar 

  25. Vickers R. Five steps to safer surgery. Ann R Coll Surg Engl. 2011;93(7):501–3. https://doi.org/10.1308/147870811x599334.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  26. Koshes R, et al. Debriefing following combat. In: Jones FD, editor. War psychiatry. Office of the Surgeon General, United States Army; 1995. p. 271–90.

    Google Scholar 

  27. United States, Congress, Marine Corps Training Command. Military briefing W3S0005 student handout, United States Marine Corps, pp. 1–14.

    Google Scholar 

  28. Lingard L. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg. 2008;143(1):12. https://doi.org/10.1001/archsurg.2007.21.

    CrossRef  PubMed  Google Scholar 

  29. Mazzocco K, et al. Surgical team behaviors and patient outcomes. Am J Surg. 2009;197(5):678–85. https://doi.org/10.1016/j.amjsurg.2008.03.002.

    CrossRef  PubMed  Google Scholar 

  30. State Recognition. The Joint Commission, 2020. www.jointcommission.org/accreditation-and-certification/state-recognition/.

  31. Ambulatory Surgery Centers (ASCs). AAAHC, 2020. www.aaahc.org/accreditation/ambulatory-surgery-centers-ascs/.

  32. American College of Surgeons (ACS) Committee on Perioperative Care. Revised statement on safe surgery checklists, and ensuring correct patient, correct site, and correct procedure surgery. American College of Surgeons. 2016. www.facs.org/about-acs/statements/93-surgery-checklists.

  33. Thomassen Ø, et al. Checklists in the operating room: help or hurdle? A qualitative study on health workers’ experiences. BMC Health Serv Res. 2010;10(1). https://doi.org/10.1186/1472-6963-10-342.

  34. Chen C, et al. Use and implementation of standard operating procedures and checklists in prehospital emergency medicine: a literature review. Am J Emerg Med. 2016;34(12):2432–9. https://doi.org/10.1016/j.ajem.2016.09.057.

    CrossRef  PubMed  Google Scholar 

  35. Jullia M, et al. Training in intraoperative handover and display of a checklist improve communication during transfer of care. Eur J Anaesthesiol. 2017;34(7):471–6. https://doi.org/10.1097/eja.0000000000000636.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  36. Haugen AS, et al. Causal analysis of World Health Organizationʼs surgical safety checklist implementation quality and impact on care processes and patient outcomes. Ann Surg. 2019;269(2):283–90. https://doi.org/10.1097/sla.0000000000002584.

    CrossRef  PubMed  Google Scholar 

  37. White MC, et al. Sustainability of using the WHO surgical safety checklist: a mixed-methods longitudinal evaluation following a nationwide blended educational implementation strategy in Madagascar. BMJ Glob Health. 2018;3(6). https://doi.org/10.1136/bmjgh-2018-001104.

  38. De Jager E, et al. Postoperative adverse events inconsistently improved by the World Health Organization surgical safety checklist: a systematic literature review of 25 studies. World J Surg. 2016;40(8):1842–58. https://doi.org/10.1007/s00268-016-3519-9.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  39. Lagoo J, et al. Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis. BMJ Open. 2017;7(10). https://doi.org/10.1136/bmjopen-2017-016298.

  40. Van Schoten SM, et al. Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: results of a National Patient Safety Programme in the Netherlands. BMJ Open. 2014;4(7). https://doi.org/10.1136/bmjopen-2014-005075.

  41. Schwendimann R, et al. Adherence to the WHO surgical safety checklist: an observational study in a Swiss Academic Center. Patient Saf Surg. 2019;13(1). https://doi.org/10.1186/s13037-019-0194-4.

  42. Russ S, et al. Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study. J Am Coll Surg. 2015;220(1). https://doi.org/10.1016/j.jamcollsurg.2014.09.021.

  43. Mulloy D. Wrong-site surgery: a preventable medical error. In: Hughes R, editor. Patient safety and quality: an evidence-based handbook for nurses. Agency for Healthcare Research and Quality, U.S. Dept. of Health and Human Services; 2008.

    Google Scholar 

  44. AORN Develops Correct Site Surgery Kit. Imaging Technology News, 4 June 2007. www.itnonline.com/content/aorn-develops-correct-site-surgery-kit.

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Amelia T. Collings & Dimitrios Stefanidis

Authors
  1. Amelia T. Collings
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitrios Stefanidis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amelia T. Collings .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Medical Center, Springfield, MA, USA

    MD John R. Romanelli

  2. Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA

    Dr. Jonathan M. Dort

  3. Department of Surgery, Lenox Hill Hospital, New York, NY, USA

    Dr. Rebecca B. Kowalski

  4. Department of Surgery, NYU Langone Medical Center, Brooklyn, NY, USA

    Dr. Prashant Sinha

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Collings, A.T., Stefanidis, D. (2022). Checklists, Surgical Timeout, Briefing, and Debriefing: Safety in the Operating Room. In: Romanelli, J.R., Dort, J.M., Kowalski, R.B., Sinha, P. (eds) The SAGES Manual of Quality, Outcomes and Patient Safety. Springer, Cham. https://doi.org/10.1007/978-3-030-94610-4_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-94610-4_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94609-8

  • Online ISBN: 978-3-030-94610-4

  • eBook Packages: MedicineMedicine (R0)