title: "Team time-out" and surgical safety-experiences in 12,390 neurosurgical patients.
abstract: OBJECTIVE
  Quality and safety are basic concerns in any medical practice. Especially in daily surgical practice, with increasing turnover and shortened procedure times, attention to these topics needs to be assured. Starting in 2007, the authors used a perioperative checklist in all elective procedures and extended the checklist in January 2011 according to the so-called team time-out principles, with additional assessment of patient identity and the planned surgical procedure performed immediately before skin incision, including the emergency cases.
  
  
  METHODS
  The advanced perioperative checklist includes parts for patient identification, preoperative assessments, team time-out, postoperative treatment, and imaging controls. All parts are signed by the responsible physician except for the team time-out, which is performed and signed by the theater nurse on behalf of the surgeon immediately before skin incision.
  
  
  RESULTS
  Between January 2007 and December 2010, 1 wrong-sided bur hole in an emergency case and 1 wrong-sided lumbar approach in an elective case (of 8795 surgical procedures) occurred in the authors' department. Using the advanced perioperative checklist including the team time-out principles, no error occurred in 3595 surgical procedures (January 2011-June 2012). In the authors' department all team members appreciate the chance to focus on the patient, the surgical procedure, and expected difficulties. The number of incomplete checklists and of patients not being transferred into the operating room was lowered significantly (p = 0.002) after implementing the advanced perioperative checklist.
  
  
  CONCLUSIONS
  In the authors' daily experience, the advanced perioperative checklist developed according to the team time-out principles improves preoperative workup and the focus of the entire team. The focus is drawn to the procedure, expected difficulties of the surgery, and special needs in the treatment of the particular patient. Especially in emergency situations, the team time-out synchronizes the involved team members and helps to improve patient safety.
authors.affiliation: Department of Neurosurgery, Intensive Care Medicine, and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. Oszvald@em.uni-frankfurt.de
authors.forename: Ági
authors.initials: Á
authors.lastname: Oszvald
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
mesh_terms: D057189:Checklist / Q000379:methods*; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D061214:Patient Safety / Q000592:standards*; D019990:Perioperative Care / Q000592:standards