Pre-surgery 'time outs'

Before you let the surgeon make that first cut, you might want to suggest a time out.

The "time out" is a review designed to prevent medical errors involving surgery on the wrong patient or the wrong body part. Left leg, instead of right. Mrs. Green instead of Mrs. Gray.

Patient safety has become a major focus since release of the landmark "To Err Is Human" report on medical errors four years ago. Starting July 1, health-care facilities accredited by the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) must follow new time-out guidelines.

The "Universal Protocol to Prevent Wrong Site, Wrong Procedure, Wrong Person Surgery" asks that patients, when possible, oversee the marking on their body where the surgery will take place. The time out itself happens in the operating room, when the surgical team huddles briefly to make sure it's the right patient, the right surgery, the right surgery site. And to double-check that the X-rays, medical files and scans being used are turned the right way and belong to the patient on the operating table.

Wednesday, the Utah Hospitals and Health Systems Association (UHA) hosted a news conference to announce Utah's effort to improve safety through time outs. Utah health care providers and officials have teamed up on the process to make things more consistent, since many doctors work at multiple facilities and changing routines can lead to mistakes and oversights.

Utah has long been a leader in patient safety, said Joseph Krella, president of UHA. What's unique, though, is the collaborative approach.

Dr. Neil Whitaker, Intermountain Health Care Urban South Region, gave frightening examples of errors averted in the operating room. He told of a surgeon who discovered that the wrong ankle had been prepped for surgery. And of a woman who had fluid in her chest cavity and a collapsed lung. Had staff not noticed the X-ray was flipped, they could have entered the wrong side of her chest, imperiling the working lung.

Time out, he said, "can help avert tragedy. I am really convinced" it will help "ensure patient safety."

Patients have to take an active role in decisions about their care, said Robyn Archer, a registered nurse with the Salt Lake Surgery Center, who noted a statewide process is being developed on where marks are made, how, who does it and more.