Scrub technician, referring to the visible site marking: "I see the mark on the left hip. Surgeon (to all members of the operating team): "Let's do the time-out."Ĭirculating nurse-after all members of the operating team have stopped what they are doing, have turned off any music, and are paying attention-reads from the informed consent: "This is Mary Jones date of birth Janutotal hip replacement left side supine position."Īnesthesia provider, referring to the visible site marking and available documents: "I verify that we are doing a left total hip replacement on Mary Jones, medical record number 007." Other individual members of the operating team: "I agree."Ĭirculating nurse: "The left hip is in the supine position and has been marked." I am doing a left total hip replacement in the supine position."Ĭirculating nurse (to the scrub technician): "Do you agree?"Ĭirculating nurse (to the anesthesia provider): "Do you agree?"Ĭirculating nurse (to all members of the operating team): "It's time for the time-out."Ĭirculating nurse (to the anesthesia provider): "What is the patient's name and date of birth?"Īnesthesia provider, reading from the armband: "Mary Jones and her date of birth is January 1, 1921."Ĭirculating nurse (to the surgeon): "What is the intended procedure?"Ĭirculating nurse: "That information matches the consent."Ĭirculating nurse (to the surgeon): "What side is to be done?"Ĭirculating nurse (to the surgeon): "Is the site mark visible?"Ĭirculating nurse (to the surgeon): "Do we have the correct position?"Ĭirculating nurse (to the surgeon): "Are relevant x-rays available, labeled, and displayed?"Ĭirculating nurse (to all members of the operating team): "Let's do our time-out."Ĭirculating nurse, after checking around the room to see that all members of the operating team involved in the patient's care have stopped what they are doing and are paying attention: "This is Mary Jones (looking at the name bracelet) her date of birth is January 1, 1921."Ĭirculating nurse, reading directly from the surgical consent: "Left total hip replacement."Ĭirculating nurse (to all members of the operating team): "Do you agree?"
Surgeon: "I concur that this is Mary Jones. Scripts for Mary Jones (DOB, MR# 007) Left Total Hip Replacement (Supine Position) Script #1Ĭirculating nurse, holding the informed consent and preoperative checklist (to the anesthesia provider): "What is the patient's name and date of birth?"Īnesthesia provider, reading from the patient label on the anesthesia record after it has been confirmed with the patient's identification bracelet: "Mary Jones, January 1, 1921."
Elements of the time-out that involve confirmation or documentation not based on conversation have also been eliminated. Implant availability, antibiotic administration, allergies, and other additions to the Universal Protocol not related to preventing wrong-site surgery have been eliminated from the time-out scripts. The Authority's Time-Out in the OR Competition, entries listed below, included only the parts of a time-out script that identify the patient, procedure, and side or site of the procedure.
Atul Gawande, MD, has stated that the aviation industry has a rule of thumb that, to maintain effectiveness, a routine checklist addressing a single task should take less than 90 seconds to perform (personal communication). The median for 227 observations was 1 minute and the mean was 90 seconds. During a regional collaborative to prevent wrong-site surgery, discussedĮlsewhere, operating room managers at 27 facilities noted the durations of the time-outs.
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