title: Why isn't 'time out' being implemented? An exploratory study.
abstract: BACKGROUND
  While there has been much discussion extolling the virtues of using 'time out' as a means of preventing the potential for sentinel events, to date there has been little examination of the issues that impact on clinicians' uptake of 'time out' in operating-room settings.
  
  
  OBJECTIVE
  This study sought to methodically identify implementation and practice issues associated with the introduction and ongoing use of a 'time out' protocol in a large healthcare organisation.
  
  
  METHODS
  Sixteen participants were interviewed and included surgeons, anaesthetists, nurse managers and nurses who worked at the clinical interface. Textual data were analysed using a grounded theory approach, identifying subcategories to illustrate causal relationships to the category.
  
  
  RESULTS
  The category 'ambivalent compliance with "time out"' was the central idea that was recognised by events and behaviours that surrounded the introduction of 'time out.' Subcategories included haphazard implementation of time out, hierarchical team culture and tribal affiliations of members, and clashing clinical priorities make it difficult to incorporate 'time out' into practice, and led to 'ambivalent compliance.'
  
  
  CONCLUSIONS
  There is little doubt that using a 'time out' protocol in the operating room allows team members to share explicit confirmation of safety-related details. However, when introducing patient safety initiatives into practice, recognising compliance issues is an important first step towards identifying ways in which to address them.
authors.affiliation: Research Centre for Clinical & Community Practice Innovation & School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia. b.gillespie@griffith.edu.au
authors.forename: Brigid M
authors.initials: BM
authors.lastname: Gillespie
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.forename: Marianne
authors.initials: M
authors.lastname: Wallis
authors.forename: Clare
authors.initials: C
authors.lastname: Fenwick
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D006801:Humans; D007407:Interviews as Topic; D009873:Operating Rooms / Q000458:organization & administration*; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*; D013597:Systems Analysis