This comes from a loyal reader who I will keep anonymous. Just like the VA mess, there are ways to game any system. That is what they pay administrators for:
As I’m sure you know, the new ‘fad’ in surgery to minimize mistakes is the “Time Out”. With all personnel and the patient in the OR, everything stops and all practitioners are to give 100% of their attention to review the operative plan. With everyone looking directly at the surgical site, consent in anesthesia’s hand, the surgeon IDs the patient with DOB and reviews what he’s going to do, that all equipment etc. has been checked and is available. The nurse confirms sterility,etc and anesthesia reviews their concerns, plan, and confirms the consent. Not a bad concept to make sure we’re all on the same page with the patient! However, our institution has decided that the patient will have anesthesia induced FIRST followed by the surgeon scrubbed up at the field with all equipment checked and ready to go before initiating the time out. Besides the obvious, that the patient can no longer be part of this conversation which includes verifying surgical site and side (if appropriate), the ‘policy’ as written is a lie. No one at my institution can answer the simple questions, “How can I possibly give 100% of my attention to the time out with a patient under anesthesia?” and “How can I leave my patients bedside to stand by the surgical site and be looking at the consent, rather than my patient?” Not to mention the fact that this patient has JUST been induced. That’s like telling the pilot, right after takeoff, “Ok, now that we’re just off the ground, let’s divert our attention from our instruments and first review our plan.” It makes me crazy.
During a procedure, I asked one of the physician policy makers my question. His response was, “You know you can pay attention to the patient too and stop the time out if necessary.” And I said, “And when the lawyer says, how could you have been paying attention to the patient when you are giving 100% of your attention to the Time Out? What should I reply?” He looked away from me and starting talking baseball with the scrub tech.
One other thing. This is all being monitored on camera by people in India! We have to actually go over and point to the surgical site since there is no audio. And since we have our masks on…for all they’d know we could be singing a round of ‘row row row your boat’ while pointing to the patient and the consent. While the idea of a Time Out can be beneficial, this is a total waste of money.
Hey, Dr. Atul Gawanade, how do you like your checklist manifesto now?