Reframing the surgical time out to fight complacency, improve outcomes

Editor's Note

On this National Time Out Day, perioperative leaders are being called to reinvigorate the time-out process to combat complacency and reduce adverse events. Despite decades of safety initiatives, the adverse event rate in surgical care remains high—38% of perioperative cases, with nearly half tied directly to surgical procedures, OR Today April 1 reports. The article, authored by Madelyn Jo May, RN, CNS, DNP, a surveyor for ACHC’s Hospital Accreditation Programs, argues that while faulty systems often cause errors, improvement lies in how individuals and teams engage with safety protocols—starting with how time outs are conducted.

The time out, often treated as a single, brief pause before incision, has become so routine in many ORs that its purpose might have become diluted. As detailed in the article, consistency without intention fosters complacency. Rushing through or skipping checklist items undermines the very safeguards the time out is designed to ensure. To reenergize this critical practice, surgical leaders should encourage active participation, vary the approach, and anchor time outs within the patient journey.

As posed by Dr May, reframing the time out as a three-step series of deliberate checks—before anesthesia, before incision, and before patient transfer from the OR—mirrors the structure of the WHO Surgical Safety Checklist and encourages continuous attention. This perspective not only helps mitigate errors but also reinforces shared team responsibility. She also recommends applying the Plan-Do-Study-Act (PDSA) model to reexamine and revitalize time-out training:

• In the "Plan" phase, teams evaluate checklist items and integrate time-out review into regular education.
• The "Do" phase includes dynamic training tactics, such as simulations with staged errors and role-switching, to prompt engagement and reinforce a speak-up culture.
• "Study" encourages feedback and real-time audits by rotating team members.
• And "Act" focuses on sharing insights to build ownership and drive improvement.

Ultimately, the article stresses that how the surgical team uses the time out—not the safety checklist itself—is key. Ensuring the surgical time out remains a meaningful, adaptive safety practice is essential to reducing risk and protecting patients.