title: The Time Out Procedure: have we changed our practice?
abstract: BACKGROUND
  A preoperative surgical safety checklist was implemented into three major hospitals performing elective operations in Christchurch (New Zealand) in 2004. A prospective analysis of the results of this "Time Out Procedure" (TOP) was performed upon its implementation and 4 years later.
  
  
  METHODS
  All members of the surgical team who participated in the TOP were recorded, as were the details of any discrepancies encountered during the TOP. The results of the initial prospective analysis from September 2004 until April 2005 (Phase 1, 10,330 procedures) were compared to a further prospective study 4 years later from October 2008 until September 2009 (Phase 2, 25,086 procedures). Surgeons' attitudes towards the TOP were analysed with a questionnaire.
  
  
  RESULTS
  There were no wrong site operations in either phases of the study. Completion of the TOP improved in Phase 2 (98% compared to 87%, p<0.001). The overall discrepancies observed increased, (7.7% in Phase 1 and 9.3% in Phase 2, p<0.001) with surgeon being absent at the TOP resulting in 73% of the discrepancies observed. Only 86% of surgeons believed that TOP was valuable in reducing wrong site operation.
  
  
  CONCLUSIONS
  This study suggests that surgical checklists such as the TOP are a useful tool in identification and prevention of wrong site surgery. Our practice with consent and limb marking has improved over the two study periods. However, there continues to be surgeon resistance to these checklists, and further research will help to identify the reasons and possible solutions to this phenomenon.
authors.affiliation: Department of Orthopaedic Surgery, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, Christchurch 8011, New Zealand. jaejinl.lee@cdhb.govt.nz
authors.forename: Alex J-J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Sumit
authors.initials: S
authors.lastname: Raniga
authors.forename: Gary
authors.initials: G
authors.lastname: Hooper
authors.forename: Ali
authors.initials: A
authors.lastname: Perry
authors.forename: Robyn
authors.initials: R
authors.lastname: Bisset
authors.forename: Diane
authors.initials: D
authors.lastname: Darley
authors.forename: Carmel
authors.initials: C
authors.lastname: Hurley-Watts
mesh_terms: D057189:Checklist / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D009520:New Zealand; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment