Variation in surgical time-out and site marking within pediatric otolaryngology

Arch Otolaryngol Head Neck Surg. 2011 Jan;137(1):69-73. doi: 10.1001/archoto.2010.232.


Objective: To determine variation in surgical time-out and site-marking within pediatric otolaryngology.

Design: Survey e-mailed via the American Society of Pediatric Otolaryngology (ASPO).

Participants: A total of 167 Children's Hospital Corp of America (CHCA) operating room (OR) directors and ASPO members were asked about perioperative preparation of their patients.

Results: Most respondents who operate at children's hospitals report policies that do not require site marking for bilateral placement of ventilation tubes, adenotonsillar surgery, airway endoscopy, or nasal surgery. Policies allowing assistants to perform site marking were identified by 45.0% of respondents from children's hospitals. Community hospitals were 3.68 times (range, 1.31-10.31 times) more likely than other facilities to permit only the attending to perform site marking. Most respondents operating at children's hospitals (84.4%) were satisfied with their hospital's site-marking policy and with their hospital's surgical checklist policy for pediatric otolaryngology procedures (87.1%). There seems to be a relationship between ear tube insertion marking policy and surgeon's age (χ² = 12.9; P = .045), area of country (χ² = 29.1; P = .004), and ambulatory centers for children (χ² = 8.1; P = .02). Twenty-one percent of survey respondents reported involvement in a wrong-site surgery at some point in their career.

Conclusions: This survey of ASPO members and CHCA OR directors reveals substantial variation in the time-out and site-marking procedures. There is a dynamic tension between universal, national mandates, and allowing local variation to encourage hospitals to tailor policies to unique needs. Further study is needed to determine if the observed variations are beneficial or harmful.

Publication types

  • Comparative Study

MeSH terms

  • Female
  • Health Care Surveys
  • Hospitals, Community / organization & administration
  • Hospitals, Pediatric / organization & administration
  • Humans
  • Male
  • Medical Errors / prevention & control*
  • Operating Rooms
  • Otolaryngology / standards*
  • Otolaryngology / trends
  • Pediatrics / standards
  • Pediatrics / trends
  • Perioperative Care / methods*
  • Perioperative Care / trends
  • Policy Making
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / trends
  • Surveys and Questionnaires
  • Time Factors
  • Total Quality Management*
  • United States