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As of July 1, all surgical teams in JCAHO-accredited hospitals, ambulatory care, and office-based surgery facilities are required to take a moment before the first cut and make sure that the team is operating on the correct patient and doing the correct surgery on the correct body part.

If you were in the OR June 23, you probably had an opportunity to take a “time-out.” Not the one imposed on small children for inappropriate behavior, but the kind designed to ensure that the right patient is getting the right surgery.

National Time Out Day was sponsored by the Association of periOperative Registered Nurses and several others of the more than 40 professional health care associations and organizations that support JCAHO’s Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Patient Surgery.

As of July 1, all surgical teams in JCAHO-accredited hospitals, ambulatory care, and office-based surgery facilities are required to take a moment before the first cut and make sure that the team is operating on the correct patient and doing the correct surgery on the correct body part. Preoperative verification, marking of the site, and the time-out, which immediately precedes the first incision, are required elements of the Universal Protocol.

The protocol also is intended for any invasive procedure, whether it’s in a surgical suite, emergency department, or radiology, said Linda Groah, RN, MSN, FAAN, chief operating officer and nurse executive for Kaiser Permanente San Francisco Medical Center and member of JCAHO’s Professional and Technical Advisory Committee. “Wrong site surgery is basically unforgivable. There’s no going back,” she said. “The hope is that the Universal Protocol will prevent these surgeries from happening.”

The protocol reflects the fourth of seven patient safety goals established by JCAHO and is intended to prevent the more than 100,000 deaths that occur annually in the health care system because of human error. “This protocol fits into the goal of making any hospitalization or health care experience for patients less traumatic and less dangerous,” Groah said.

Groah, as a past president of AORN and a nurse for 40 years, is aware of the importance of multidisciplinary approaches to patient safety. She also has encountered some resistance from surgeons about implementing the protocol because it’s feared that it will take too much time.

“That’s not true,” Groah said. “The time-out only needs to take 30 seconds to verify the patient, the site, the procedure, the position of the patient, imaging studies, the medical record, and any special equipment or implants.” She recognizes that people are struggling with the protocol, but because it requires that everyone take time to focus on the patient, she also believes that communication among the multidisciplinary team will be improved.

Time for action

Although the time-out procedure requires some patience from the surgical team, the theme of the recent National Patient Safety Foundation Congress — “Let’s Get On with It!” — conveys the impatience that many national health care leaders and clinicians feel about the overall state of patient safety. May 3-7, the sixth Annual Congress in Boston was attended by 1,300 nurses, physicians, risk managers, policy-makers, engineers, and others who heard about policies, programs, and research that bring about better practices to safeguard patients.

Connie Crowley Ganser, RN, MS, who attended the congress, said that the theme reflected her own impatience. “Pretty universally, people have recognized that patient safety is important,” she said. “There is, however, a sense of challenge from where we are now to where health care is a more highly resilient industry.”

Ganser is founder and principal of a consulting practice, Health Care Strategies for Patient Safety and Quality. She recently started the business after working for many years in risk management, quality, and patient safety. “One of the biggest challenges is getting beyond the concept of regulation and compliance, and really driving patient safety agendas that are unique and specific to individual organizations,” she said.

One organization that has been able to do this, Ganser said, is Virginia Mason Medical Center in Seattle.