Expanded surgical time out: a key to real-time data collection and quality improvement.
Some of the concepts contained here have been discussed and incorporated in another publication, but the data are entirely unique to this manuscript. (See: Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause." Backster A, Teo A, Swift M, MD, Polk HC Jr, MD, FACS, Harken AH, MD, FACS. J Cardiac Surg, in press.)


BACKGROUND
The increasing push for quality improvement coincides with the slowly growing use of surgical time out (STO) to lessen the likelihood of wrong-site operation. We believe that the use of STO as a reflective pause or a preoperative briefing has broader value. The purpose of this article is to describe one institution's experience with this technique and to validate its potential use by others.


METHODS
An enhanced use of STO was conducted in a 400-bed teaching hospital in calendar year 2006. Before and after conducts and constructs were rated.


RESULTS
The institution found the technique to be of value, and substantially clarified and improved its performances with respect to prophylactic antibiotic choice and timing; appropriate maintenance of intraoperative temperature and glycemia; and institution of secondary issues, such as maintenance of beta-blockade and appropriate venous thromboembolism prophylaxis. Surgeon leadership and real-time data collection became essential and helpful components.


CONCLUSIONS
Prompt feedback to surgeons is vital; identification of future targets for performance improvement is feasible, although useless measures are eliminated. Because surgeons grapple with pay-for-performance, STO is a useful safety, data, and quality improvement tool.
Altpeter
Terry
T
University of Louisville Hospital, Department of Surgery, University of Louisville School of Medicine and Quality, Louisville, KY 40292, USA.
Luckhardt
Kitty
K
Lewis
John N
JN
Harken
Alden H
AH
Polk
Hiram C
HC
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001786:Blood Glucose / Q000032:analysis; D001831:Body Temperature; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D008991:Monitoring, Physiologic; D010355:Patient Identification Systems; D011785:Quality Assurance, Health Care; D017751:Safety Management / Q000458:organization & administration; D013514:Surgical Procedures, Operative / Q000592:standards*; D013923:Thromboembolism / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose