Expanded surgical time out: a key to real-time data collection and quality improvement

J Am Coll Surg. 2007 Apr;204(4):527-32. doi: 10.1016/j.jamcollsurg.2007.01.009.


Some of the concepts contained here have been discussed and incorporated in another publication, but the data are entirely unique to this manuscript. (See: Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause." Backster A, Teo A, Swift M, MD, Polk HC Jr, MD, FACS, Harken AH, MD, FACS. J Cardiac Surg, in press.)

Background: The increasing push for quality improvement coincides with the slowly growing use of surgical time out (STO) to lessen the likelihood of wrong-site operation. We believe that the use of STO as a reflective pause or a preoperative briefing has broader value. The purpose of this article is to describe one institution's experience with this technique and to validate its potential use by others.

Study design: An enhanced use of STO was conducted in a 400-bed teaching hospital in calendar year 2006. Before and after conducts and constructs were rated.

Results: The institution found the technique to be of value, and substantially clarified and improved its performances with respect to prophylactic antibiotic choice and timing; appropriate maintenance of intraoperative temperature and glycemia; and institution of secondary issues, such as maintenance of beta-blockade and appropriate venous thromboembolism prophylaxis. Surgeon leadership and real-time data collection became essential and helpful components.

Conclusions: Prompt feedback to surgeons is vital; identification of future targets for performance improvement is feasible, although useless measures are eliminated. Because surgeons grapple with pay-for-performance, STO is a useful safety, data, and quality improvement tool.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Antibiotic Prophylaxis
  • Blood Glucose / analysis
  • Body Temperature
  • Humans
  • Medical Errors / prevention & control*
  • Monitoring, Physiologic
  • Patient Identification Systems
  • Quality Assurance, Health Care*
  • Safety Management / organization & administration
  • Surgical Procedures, Operative / standards*
  • Thromboembolism / prevention & control


  • Adrenergic beta-Antagonists
  • Blood Glucose