title: Novel use of electronic whiteboard in the operating room increases surgical team compliance with pre-incision safety practices.
abstract: BACKGROUND
  Despite evidence that use of a checklist during the pre-incision time out improves patient morbidity and mortality, compliance with performing the required elements of the checklist has been low. In an effort to improve compliance, a standardized time out interactive Electronic Checklist System [iECS] was implemented in all hospital operating room (OR) suites at 1 institution. The purpose of this 12-month prospective observational study was to assess whether an iECS in the OR improves and sustains improved surgical team compliance with the pre-incision time out.
  
  
  METHODS
  Direct observational analyses of preprocedural time outs were performed on 80 cases 1 month before, and 1 and 9 months after implementation of the iECS, for a total of 240 observed cases. Three observers, who achieved high interrater reliability (kappa = 0.83), recorded a compliance score (yes, 1; no, 0) on each element of the time out. An element was scored as compliant if it was clearly verbalized by the surgical team.
  
  
  RESULTS
  Pre-intervention observations indicated that surgical staff verbally communicated the core elements of the time out procedure 49.7 ± 12.9% of the time. After implementation of the iECS, direct observation of 80 surgical cases at 1 and 9 months indicated that surgical staff verbally communicated the core elements of the time out procedure 81.6 ± 11.4% and 85.8 ± 6.8% of the time, respectively, resulting in a statistically significant (P < .0001) increase in time out procedural compliance.
  
  
  CONCLUSIONS
  Implementation of a standardized, iECS can dramatically increase compliance with preprocedural time outs in the OR, an important and necessary step in improving patient outcomes and reducing preventable complications and deaths.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA. rajshri.mainthia@vanderbilt.edu
authors.forename: Rajshri
authors.initials: R
authors.lastname: Mainthia
authors.forename: Timothy
authors.initials: T
authors.lastname: Lockney
authors.forename: Alexandr
authors.initials: A
authors.lastname: Zotov
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
authors.forename: Marc
authors.initials: M
authors.lastname: Bennett
authors.forename: Paul J
authors.initials: PJ
authors.lastname: St Jacques
authors.forename: William
authors.initials: W
authors.lastname: Furman
authors.forename: Stephanie
authors.initials: S
authors.lastname: Randa
authors.forename: Nancye
authors.initials: N
authors.lastname: Feistritzer
authors.forename: Roland
authors.initials: R
authors.lastname: Eavey
authors.forename: Susie
authors.initials: S
authors.lastname: Leming-Lee
authors.forename: Shilo
authors.initials: S
authors.lastname: Anders
mesh_terms: D057189:Checklist / Q000295:instrumentation*; D013502:General Surgery / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015588:Observer Variation; D009873:Operating Rooms / Q000592:standards*; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011446:Prospective Studies