Implications for Patient and Provider Safety
The origins of the surgical time-out can be traced back to safety
checklists used in the aeronautic industry9. The
philosophy of usage influences how timeouts or checklists are
conducted10. A procedural time-out may function as a
to-do list or as a backup process to verify tasks completed from memory.
The time-out is designed to protect against errors from memory recall.
There is usually a component of mutual redundancy in conducting a
time-out as multiple team members can monitor each other’s
responses10. Taking cues from other high reliability
organizations, the World Health Organization designed a surgical safety
checklist which resulted in reducing patient morbidity, mortality, and
complication rates11,12. In the setting of the
COVID-19 pandemic, several academic organizations have released
guidelines on performing a tracheostomy. These recommendations are aimed
at safety measures to mitigate transmission risk of SARS-CoV-2. Given
the potential consequences for error, these standardized operating
practices for tracheostomy should not be carried out simply from memory
recall. Use of a dedicated tracheostomy time-out will allow for safety
measures to be verified in a consistent manner. There are several key
advantages to using the tracheostomy time-out: review of critical steps
by multiple team members, improvement in communication between OR
personnel, and an emphasis on quality control. Disadvantages include
possible time delays and checklist fatigue. In order to address this, we
have made the tracheostomy time-out focused and concise. If performed
without interruptions, the time-out can be completed in under 1 minute.