Methodology to evaluate the effectiveness of instituting a modified preoperative time out on teamwork: a pilot study

Abstract

To evaluate the effectiveness of modifying the preoperative surgical time out in increasing a validated measure of teamwork in the operating room.

Methods: This study was conducted as a pre-intervention, post-intervention pilot study. A validated survey was used as an instrument to measure overall teamwork in the operating room. Data were obtained in two periods of time: In phase 1 (pre-intervention), the standard preoperative surgical time out was used. In phase 2 (post-intervention), a modification of the standard time out was employed, emphasizing the equality and importance to safety of listening to the opinions of all team members in the room.

Results: The use of an enhanced surgical time out was shown to have a small, but measurable positive correlation with a validated measure of operating room teamwork. Mean survey Likert scores increased from 68.03 to 68.81 out of a total survey score of 90, with an appropriate control range shift. Although this small pilot study was insufficiently powered to evaluate subcategories of teamwork, such as clinical leadership, communication, coordination, and respect, we hope to address this in future larger studies.

Conclusion: Our data from this pilot study suggest that giving each member of the surgical room team a position of equality in analyzing the operating room environment prior to commencing surgery led to a positive, measurable difference in an objective measure of teamwork. Increases in teamwork have been shown in the literature to lead to an overall safer surgical environment.

Keywords: operating room; quality improvement study; surgical safety; teamwork.