title: Impact of the time-out process on safety attitude in a tertiary neurosurgical department.
abstract: OBJECTIVE
  In July 2011, the UCLA Health System released its current time-out process protocol used across the Health System. Numerous interventions were performed to improve checklist completion and time-out process observance. This study assessed the impact of the current protocol for the time-out on healthcare providers' safety attitude and operating room safety climate.
  
  
  METHODS
  All members involved in neurosurgical procedures in the main operating room of the Ronald Reagan UCLA Medical Center were asked to anonymously complete an online survey on their overall perception of the time-out process.
  
  
  RESULTS
  The survey was completed by 93 of 128 members of the surgical team. Overall, 98.9% felt that performing a pre-incision time-out improves patient safety. The majority of respondents (97.8%) felt that the team member introductions helped to promote a team spirit during the case. In addition, 93.5% felt that performing a time-out helped to ensure all team members were comfortable to voice safety concerns throughout the case. All respondents felt that the attending surgeon should be present during the time-out and 76.3% felt that he/she should lead the time-out. Unanimously, it was felt that the review of anticipated critical elements by the attending surgeon was helpful to respondents' role during the case. Responses revealed that although the time-out brings the team together physically, it does not necessarily reinforce teamwork.
  
  
  CONCLUSIONS
  The time-out process favorably impacted team members' safety attitudes and perception as well as overall safety climate in neurosurgical ORs. Survey responses identified leadership training and teamwork training as two avenues for future improvement.
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: McLaughlin
authors.affiliation: Department of Quality Management, Ronald Reagan UCLA Medical Center and Santa Monica UCLA Medical Center & Orthopedic Hospital, University of California, Los Angeles, California, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Winograd
authors.affiliation: Department of Quality Management, Ronald Reagan UCLA Medical Center and Santa Monica UCLA Medical Center & Orthopedic Hospital, University of California, Los Angeles, California, USA.
authors.forename: Hallie R
authors.initials: HR
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Van de Wiele
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA. Electronic address: neilmartin@mednet.ucla.edu.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martin
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000776:Anesthesiology / Q000458:organization & administration; D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D007857:Leadership; D009493:Neurosurgery / Q000458:organization & administration*; D009871:Operating Room Nursing / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration*; D066231:Surgeons / Q000523:psychology; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000458:organization & administration*
keywords: Leadership; Neurosurgery; Safety attitude; Teamwork; Time-out