Wrong site and wrong patient procedures are theoretically 100 percent preventable and should never happen. Despite the widespread implementation of the Universal Protocol of Time-Out since 2004-2005, multiple reports have documented continued occurrence of wrong side/site and wrong patient procedures in the United States.
In 2003, the Joint Commission made the elimination of wrong side/site surgeries a National Patient Safety Goal, and the following year required compliance with a Time-Out protocol. The Universal Protocol requires three separate steps: the proper preoperative identification of the patient by all members of the team; marking of the operative site; and a final Time-Out just prior to the surgery or procedure, regardless of where it is being performed.
The Time-Out portion and the protocol of St. Clair Hospital requires an “active attentive communication among all members of the surgical/procedural team, consistently initiated by a designated member of the team, conducted in a fail-safe mode,” so the planned procedure is not started if a member of the team has concerns.
A bright yellow cloth that includes the letters S.T.O.P. (Surgical Time Out Procedure) as a prominent visual reminder to implement Time-Out Protocol and prevent wrong side/site surgery is implemented in all surgical and procedural areas of St. Clair Hospital. The Time-Out cloth covers the surgical instruments or is placed on or near the patient. It is a great reminder to not pick up a surgical instrument or equipment until the Time-Out is complete. As surgical Time-Outs become a routine part of every invasive procedure, such creative methods as the Time-Out cloth help busy medical professionals to remember to stop and double check everything.
Scott A. Holekamp, M.D. specializes in colon and rectal surgery at St. Clair Hospital. He practices with Colorectal Surgical Associates, Mt. Lebanon. To contact Dr. Holekamp, please call 412.572.6192.
