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Timeout procedure in paediatric surgery: effective tool or lip service? A randomised prospective observational study
  1. Oliver J Muensterer1,2,
  2. Hendrik Kreutz1,
  3. Alicia Poplawski3,
  4. Jan Goedeke1
  1. 1 Pediatric Surgery, Johannes Gutenberg University, Mainz, Rhineland-Palatinate, Germany
  2. 2 Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Bayern, Germany
  3. 3 Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University, Mainz, Rheinland-Pfalz, Germany
  1. Correspondence to Dr Oliver J Muensterer, Pediatric Surgery, Johannes Gutenberg University, Mainz, RP, Germany; oliver.muensterer{at}att.net

Abstract

Background For over a decade, the preoperative timeout procedure has been implemented in most paediatric surgery units. However, the impact of this intervention has not been systematically studied. This study evaluates whether purposefully introduced errors during the timeout routine are detected and reported by the operating team members.

Methods After ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a paediatric surgery attending. Errors were randomly selected among wrong name, site, side, allergy, intervention, birthdate and gender items. The main outcome measure was how frequent an error was reported by the team and by whom.

Results Over the course of 16 months, 1800 operations and timeouts were performed. Errors were randomly introduced in 120 cases (6.7%). Overall, 54% of the errors were reported; the remainder went unnoticed. Errors were pointed out most frequently by anaesthesiologists (64%), followed by nursing staff (28%), residents-in-training (6%) and medical students (1%).

Conclusion Errors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.

  • human error
  • medical error
  • measurement/epidemiology
  • Paediatrics
  • safety culture
  • surgery

Data availability statement

The anonymised, non-identifiable data this study is based on are available upon request. Requests should be directed to the corresponding author. Reuse is permitted for scientific purposes and quality initiatives.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

The anonymised, non-identifiable data this study is based on are available upon request. Requests should be directed to the corresponding author. Reuse is permitted for scientific purposes and quality initiatives.

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Footnotes

  • Contributors OJM: conception of study, participation in the timeout procedures, data interpretation, drafting of the manuscript. JG: participation in the timeout procedures, data interpretation and review of the manuscript. Mentorship to HK: randomisation, monitoring in the operating room, recording of data, analysis and review of the manuscript. AP: statistical design and analysis, review of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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