title: A survey of the use of time-out protocols in emergency medicine.
abstract: BACKGROUND
  Time-outs, as one of the elements of the Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery has been in effect since July 1, 2004. Time-outs are required by The Joint Commission for all hospital procedures regardless of location, including emergency departments (EDs). Attitudes about ED time-outs were assessed for a sample of senior emergency physicians serving in leadership roles for a national professional society.
  
  
  METHODS
  A survey questionnaire was administered to members of the American College of Emergency Physicians (ACEP) Council at the October 2009 ACEP Council meeting on the use of time-outs in the ED. A total of 225 (72%) of the 331 councilors present filled out the survey.
  
  
  RESULTS
  Twenty-nine (13%) of respondents were unaware of a formal time-out policy in their ED, 79 (35%) reported that ED time-outs were warranted, and 5 (2%) reported they knew of an instance where a time-out may have prevented an error. Chest tubes (167 respondents [74%]) and the use of sedation (142 respondents [63%]) were most commonly identified as ED procedures that necessitated a time-out. Episodes of any wrong-site error in their EDs were reported by 16 (7%) of the respondents. Wrong patient (9 respondents [4%]) and wrong procedure (2 respondents [1%]) errors were less common.
  
  
  CONCLUSIONS
  Although the time-out requirement has been in effect since 2004, more than 1 in 10 of ED physicians in this sample ofED physician leaders were unaware of it. According to the respondents, medical errors preventable by time-outs were rare; however, time-outs may be useful for certain procedures, particularly when there is a risk of wrong-site, wrong-patient, or wrong-procedure medical errors.
authors.affiliation: Department of Emergency Medicine, Albert Einstein Medical Center, Jefferson Medical College, Philadelphia, USA. KELLYJ@einstein.edu
authors.forename: John J
authors.initials: JJ
authors.lastname: Kelly
authors.forename: Heather
authors.initials: H
authors.lastname: Farley
authors.forename: Christi
authors.initials: C
authors.lastname: O'Cain
authors.forename: Robert I
authors.initials: RI
authors.lastname: Broida
authors.forename: Kevin
authors.initials: K
authors.lastname: Klauer
authors.forename: Drew C
authors.initials: DC
authors.lastname: Fuller
authors.forename: Helmut
authors.initials: H
authors.lastname: Meisl
authors.forename: Michael P
authors.initials: MP
authors.lastname: Phelan
authors.forename: Elaine
authors.initials: E
authors.lastname: Thallner
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
mesh_terms: D002985:Clinical Protocols / Q000592:standards; D004635:Emergency Medicine / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D017751:Safety Management / Q000379:methods / Q000592:standards*