TIMEOUT!
I am a patient advocate but my clinical practice was spent in the operating room. I spent almost twenty years advocating for patients during surgery. Surgical intervention saves lives. No question. In fact, worldwide 1 in 25 people every year will have surgery and although there is significant risk associated with surgical intervention, surgery is often not only life saving but transformative. Think trauma accident where surgical intervention saved a life, or on a more routine scale, a total joint replacement for a patient with debilitating knee pain. Incredible, really, when you stop to think about all the things surgery can do to save and improve lives.
The purpose of a surgical timeout is so that the TEAM can discuss pertinent details related to your surgery and communicate any questions or concerns. It is a safety check right before your surgery.
On the flip side, surgical errors happen all too frequently and contribute to medical errors that have devastating, sometimes life-ending consequences for the patient. Let’s take wrong-site surgery, for example. You would think in the current atmosphere of patient safety, wrong-site surgery would never occur. Theoretically, wrong-site surgery is NEVER supposed to occur and is actually called a “never event”. With all the safety precautions we have put in place in the last ten years, to include a “timeout” where the surgical team pauses before the surgery begins to verify the right patient, the right surgery, the correct surgical site, and any other pertinent information or questions, you would think that a “never event” such as this would NEVER occur. Guess how often it still occurs? Wrong-site surgery is estimated to occur 40 times a week in the United States. Folks, that is five times a day in this country and while these numbers make wrong-site surgery a rare occurrence, it still means we perform surgery on the WRONG site!
These estimates come from figures from states with mandatory reporting requirements. Wait….what? Some states do not have mandatory reporting requirements on wrong-site surgery….whoa….that is a whole other post.
What does the team do when the surgeon leaves the room during this critical part of care? Mostly they say nothing and pretend it didn’t happen. People are afraid to speak up. Afraid that they will be yelled at, humiliated, made to feel less than, and that is exactly what happened.
The facts speak for themselves, but I want to share a story with you from someone who has seen it from the inside. Imagine you are going to have your knee replaced- a total joint replacement for debilitating knee pain. Basically your x-ray shows you walking “bone on bone” where the cushy padding that protects your femur from your tibia is all but gone, ouch!!! Imagine you are in the operating room and you are drifting off to sleep with a little Crosby Stills & Nash on Pandora, next thing you know, you are waking up in the recovery room and your knee has been replaced.
Thankfully, you were not awake to witness what happened before your procedure when we stopped to perform the timeout. The purpose of a surgical timeout is so that the TEAM can discuss pertinent details related to your surgery and communicate any questions or concerns. It is a safety check right before your surgery.
Except, in this case as your surgical nurse, I advocated for you while you were asleep. We waited until the surgeon returned and I told him we needed to redo the timeout.
Sounds reasonable, right? No sweat. The surgeon started with your name and the procedure to be performed, he met all the requirements of the timeout. Next, the anesthesiologist spoke to his part of your care, but then the surgeon walked out of the room to take a phone call. Yes, a personal phone call. “TIMEOUT!” What about the rest of the surgical team? The surgical nurse and the surgical scrub technician are also part of the team. What if the nurse had pertinent information she wanted to communicate to the rest of the team? What does the team do when the surgeon leaves the room during this critical part of care? Mostly they say nothing and pretend it didn’t happen. People are afraid to speak up. Afraid that they will be yelled at, humiliated, made to feel less than, and that is exactly what happened. Except, in this case as your surgical nurse, I advocated for you while you were asleep. We waited until the surgeon returned and I told him we needed to redo the timeout.
To which he replied…
“Are you Fucking kidding me?”
“No, the timeout is meant to include the entire team so that we can be 100% certain we are all on the same page BEFORE we replace this patient’s knee,” I stated.
He continued: “This is fucking ridiculous. let me ask you something….do you always follow the rules, do you always drive the speed limit?”
At this point, I literally wanted to crawl in a hole and die. The shame and humiliation I felt at that moment were almost enough to make me backtrack and tell everyone it didn’t matter. However, I stood my ground and we re-did the timeout.
It is an easy thing to do in the fast-paced, high technology environment of the surgical suite. Why does this have to be such a sore point for people on the surgical team?
I always wonder how this patient would have felt if he/she had known this happened during their surgery. How would he/she have felt about our ability as a team to actually perform this procedure successfully?
Timeout was invented for a reason.
What kind of atmosphere in the surgical suite lends itself to quality care? Certainly not this one. My point in this: Timeout was invented for a reason. Since it’s inception, studies have shown that wrong-site surgery is prevented when the timeout is utilized as a means to communicate and collaborate. It is an easy thing to do in the fast-paced, high technology environment of the surgical suite. Why does this have to be such a sore point for people on the surgical team? I have been witness to surgeons who think the timeout is a waste of time, scrub technicians who are more interested in their table of instruments, nurses who are more concerned with their paperwork than their patients, to anesthesiologists who would rather read the paper than be bothered with a timeout. No joke, I am not kidding.
So let me ask you this: If you knew that you were going to have your knee replaced and the surgeon or any other member of your surgical team did not perform a very easy safety check, would you want them to perform your surgery?
I write this blog as a nurse patient advocate so that you, the patient, can be a better consumer and advocate for your care when faced with surgery. Ask questions, get informed, and do not have surgery until you feel confident that your team is the right team for you.
Cobb, T. K. (2012). Wrong-site surgery—where are we and what is the next step? Hand, 7(2), 229–232. doi.org/10.1007/s11552-012-9405-5
Weiser,T.G., Regenbogen, S.E., Thompson, K.D., Haynes, A.B., Lipsitz, S.R., William, B.R., & Gawande, A.A. (2008). An estimation of the global volume of surgery: a modeling. Lancet, 372, 139-144. doi:10.1016/S01406736(08)60878-8