The Timeout Process

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The implementation of the timeout processes could well be the most important procedure to be introduced to the operating theatre in recent times. This seemingly small change has had a dramatic impact on patient outcome, staff cohesion and cost reduction in medical institutions. However, there are still issues that are obstructing the effectiveness of the timeout, namely poor compliance by some team members who believe that the fast turnover of cases does not allow for the timeout, that they have never had a problem in the past or that the timeout is questioning their competence. This essay will look at the positive outcome that the timeout process has had in the operating theatre, why it is working and how to ensure that it remains a priority. The writer will also address the problem of poor compliance by some members, why they are resistant to the timeout process and what can be done to ensure their co-operation thereby creating a positive outcome for more patients. In order to place the checklist process in a proper perspective the following historical event is provided: In aviation, pilots have been using checklist since 1935. It was formulated after the crash of the new Boeing Model 299 on its test flight, which killed two of the five crew members. One of the fatalities was Major Ployer P. Hill the Air Corps’ Chief of Flight Testing. The ensuing investigation ruled that the accident was pilot error and not mechanical failure. As the result of this ruling a group of test pilots took it upon themselves to investigate the reason for the pilot error. They concluded that the new technology had a lot more sequential steps for the pilot to follow than the older aircrafts, which made it easier for Major Ployer P.Hill, a highly experienced pilot, to have missed a crucial step. The solution they formulated to rectify this dilemma was a simple checklist. By following this checklist the Model 299 was flown for 1.8 million miles without an accident. Gawande (2010, p. 32 – 34). Likewise, the nursing profession has been using checklists in various forms, from the implementation of routine recording of vital signs to medication charts. However, it was only in 2001 that a critical care specialist, Peter Pranovost, decided to formulate a simple checklist to try and reduce central line infections in the ICU at the John Hopkins Hospital, where he was working at the time. Peter Pranovost and his colleagues monitored the results of their idea for a year. In that time the ten-day line infection rate went from 11 percent to zero. They proceeded to test other checklists with equally impressive results. (Gawande 2010, p. 37- 39) Several studies were done on surgical outcomes that showed that about half of the complications experienced could have been prevented through the use of this checklist. In these studies it was shown “that in industrial countries major complications occur in 3% to 16% of inpatient surgical procedures, and permanent disability or death rates are about 0.4% to 0.8%. In developing countries, studies suggest death rates of 5% to 10 % during major operations. Mortality from general anaesthesia alone is reported to be as high as one in 150 in parts of sub-Saharan Africa. Infections and other postoperative complications are also a serious concern around the world.” WHO (2007). In 2007 the World Health Organization (WHO) decided that something must be done to improve the situation A team of experts, led by Dr Atule Gawande, was brought together to find a solution. They formulated the surgical checklist and challenged the world to use it. “The group investigated the impact of the WHO checklist in eight hospitals worldwide, four in high-income settings and four in low and middle-income settings. Data on in-hospital complications occurring within the first 30 days after surgery were collected prospectively from consecutively enrolled adult patients undergoing non-cardiac surgery, 3733 before and 3955 after the...
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