title: Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: results of a national patient safety programme in the Netherlands.
abstract: OBJECTIVE
  To prevent wrong surgery, the WHO 'Safe Surgery Checklist' was introduced in 2008. The checklist comprises a time-out procedure (TOP): the final step before the start of the surgical procedure where the patient, surgical procedure and side/site are reviewed by the surgical team. The aim of this study is to evaluate the extent to which hospitals carry out the TOP before anaesthesia in the operating room, whether compliance has changed over time, and to determine factors that are associated with compliance.
  
  
  METHODS
  Evaluation study involving observations.
  
  
  METHODS
  Operating rooms of 2 academic, 4 teaching and 12 general Dutch hospitals.
  
  
  METHODS
  A random selection was made from all adult patients scheduled for elective surgery on the day of the observation, preferably involving different surgeons and different procedures.
  
  
  RESULTS
  Mean compliance with the TOP was 71.3%. Large differences between hospitals were observed. No linear trend was found in compliance during the study period. Compliance at general and teaching hospitals was higher than at academic hospitals. Compliance decreased with the age of the patient, general surgery showed lower compliance in comparison with other specialties and compliance was higher when the team was focused on the TOP.
  
  
  CONCLUSIONS
  Large differences in compliance with the TOP were observed between participating hospitals which can be attributed at least in part to the type of hospital, surgical specialty and patient characteristics. Hospitals do not comply consistently with national guidelines to prevent wrong surgery and further implementation as well as further research into non-compliance is needed.
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Steffie M
authors.initials: SM
authors.lastname: van Schoten
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Veerle
authors.initials: V
authors.lastname: Kop
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands Faculty Economics and Business, Department Operations, University of Groningen, Groningen, The Netherlands.
authors.forename: Carolien
authors.initials: C
authors.lastname: de Blok
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands Departments of Sociology and Human Geography, Utrecht University, Utrecht, The Netherlands.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Vrije Universiteit Medical Center (VUmc), Amsterdam, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D009426:Netherlands; D061214:Patient Safety / Q000592:standards*; D055815:Young Adult
keywords: SOCIAL MEDICINE; SURGERY