The Importance of the Time Out

[Monty Python]

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I'll admit, I was a little annoyed when we started doing Time-Outs. Slowly I've become an advocate for them, with my feelings reinforced after reading today's headline:

http://www.foxnews.com/story/0,2933,339270,00.html

 

[jwk]

I'll admit, I was a little annoyed when we started doing Time-Outs. Slowly I've become an advocate for them, with my feelings reinforced after reading today's headline:

http://www.foxnews.com/story/0,2933,339270,00.html

Let's be honest folks - things along this line happen much more often than any of us will be willing to admit in a public forum. It's amazing that people are still taking shortcuts with this issue - doing timeouts after the incision is made is still seen frequently, and mistakes DO happen.

Our hospital has just started using a separate time-out form and it lists everyone present in the room at the time the timeout was done. We don't have to sign it - yet - but I'll bet that's not far off in the future.

 

[Planktonmd]

I'll admit, I was a little annoyed when we started doing Time-Outs. Slowly I've become an advocate for them, with my feelings reinforced after reading today's headline:

http://www.foxnews.com/story/0,2933,339270,00.html

The bright side is that she won't even be charged for the new anus and she will make some serious money suing everyone.

 

[VentdependenT]

Time out is fine with me. Only takes about 10 seconds. However, as anesthesia providers, we routinely have somebody else go pre-op the patient out front and then briefly say HI and roll back. So we potentially have no idea of who the patient is except from their slot number and what it says on the PAR/ASU board.

For times like that I always check the wristband during the Time Out and my anesthetic record. I do the same when I find myself in the all too common situation requiring blood transfusion (versus just checking the plate and its imprint on my record) in patients in rooms I've taken over/giving breaks to.

 

[Intubate]

The problem is, time outs don't work. It becomes so routine that it is ignored. When they review most wrong sided surgeries, someone in the room was usually aware that a mistake was being made, but didn't say anything. Scary.

 

[militarymd]

We have begun our slide down the slippery slope of losing physician autonomy and you guys don't even know it.

I'm hearing people say..."I'm getting used to it"

"it's ok with me"

10 years ago...if this was EVEN suggested....MD's would have said f uc k you and moved to make their millions somewhere else.



now....we say "sounds like a good idea"....while our income and autonomy continues to drop.

This is COMPLETE BU LL SH IT....and its our own fault.....

Being a doctor ain't what it used to be.....and in another 20 years...being a doctor will be no different than that loser wearing a funny hat saying, " you want fries with that lap chole?"

 

[nchhabra]

anyone have to do these for labor epidurals? joint comission made us start doing this recently. seems ******ed to me. i usually get a call from the nurse, saying ldr so and so wants an epidural. i go in see the patient, do my preop, walk out, get my epidural cart, and go back in the room. is it likely that a different pregnant patient has hopped into bed that i need to do a timeout? if i am feeling a little crazy, i may do a cse instead of just an epidural. amazingly enough, i never put anything other than a lumbar epidural in for labor. but every time, after i have positioned the patient, i have to say, "this is ms. x. i am going to place a lumbar epidural catheter for labor analgesia." all this has to be documented and witnessed by an rn and a copy placed in the patient's chart.

 

[Coastie]

So...adding checks and balances to decrease liability, with zero cost to the overhead, and increasing quality of care delivered is a bad thing?

Where is your business hat today?

We have begun our slide down the slippery slope of losing physician autonomy and you guys don't even know it.

I'm hearing people say..."I'm getting used to it"

"it's ok with me"

10 years ago...if this was EVEN suggested....MD's would have said f uc k you and moved to make their millions somewhere else.



now....we say "sounds like a good idea"....while our income and autonomy continues to drop.

This is COMPLETE BU LL SH IT....and its our own fault.....

Being a doctor ain't what it used to be.....and in another 20 years...being a doctor will be no different than that loser wearing a funny hat saying, " you want fries with that lap chole?"

 

[coprolalia]

We have begun our slide down the slippery slope of losing physician autonomy and you guys don't even know it.

I'm hearing people say..."I'm getting used to it"

"it's ok with me"

10 years ago...if this was EVEN suggested....MD's would have said f uc k you and moved to make their millions somewhere else.



now....we say "sounds like a good idea"....while our income and autonomy continues to drop.

This is COMPLETE BU LL SH IT....and its our own fault.....

Being a doctor ain't what it used to be.....and in another 20 years...being a doctor will be no different than that loser wearing a funny hat saying, " you want fries with that lap chole?"

Oh, the irony of those statements above...

http://forums.studentdoctor.net/showpost.php?p=6020535&postcount=29

http://gasforums.studentdoctor.net/showpost.php?p=6334485&postcount=17



-copro

 

[militarymd]

Oh, the irony of those statements above...

http://forums.studentdoctor.net/showpost.php?p=6020535&postcount=29

http://gasforums.studentdoctor.net/showpost.php?p=6334485&postcount=17



-copro

Where's the irony?

It is the same sentiment in all the posts.

We're having to put up with Bull****...which is OUR own fault for allowing it....Still bull****....

and my advice still stands...get used to it........or you have to get out.

 

[militarymd]

So...adding checks and balances to decrease liability, with zero cost to the overhead, and increasing quality of care delivered is a bad thing?

Where is your business hat today?

It doesn't decrease liability...wrong site surgery rates have not gone down....however we're wasting time like you wouldn't believe.

And you know what the smart, fast, surgeons do?

They open their own surgery centers and bring their paying patients there so they don't have to put up with b s...and bring the medicare stuff to the hospital.


and the hospital administrators wonder why they're (and those of us who work there) are suffering.



we'll see what the CMS changes in facility fees will do.

 

[coprolalia]

Where's the irony?

It is the same sentiment in all the posts.

We're having to put up with Bull****...which is OUR own fault for allowing it....Still bull****....

and my advice still stands...get used to it........or you have to get out.

So, we can't do anything about it... and you're getting out...

I'll use your same statement back to you: why are you all upset?

-copro

 

[Coastie]

Fair enough. I thought it decreased the incidence of screw ups, but perhaps I've been told the wrong data.

I'm all about surgery centers and private hospitals leeching the best cases. Perhaps it will add some economy to this otherwise overwhelmingly socialistic and broken system...

It doesn't decrease liability...wrong site surgery rates have not gone down....however we're wasting time like you wouldn't believe.

And you know what the smart, fast, surgeons do?

They open their own surgery centers and bring their paying patients there so they don't have to put up with b s...and bring the medicare stuff to the hospital.


and the hospital administrators wonder why they're (and those of us who work there) are suffering.



we'll see what the CMS changes in facility fees will do.

 

[militarymd]

So, we can't do anything about it... and you're getting out...

I'll use your same statement back to you: why are you all upset?

-copro

because it takes away from my bottomline. $$$

 

[coprolalia]

because it takes away from my bottomline. $$$

A 15-second "time out"? How?

And, your initial post was nothing about a "bottom line" but a rant against loss of physician autonomy.

😕

-copro

 

[militarymd]

A 15-second "time out"? How?

And, your initial post was nothing about a "bottom line" but a rant against physician autonomy.

😕

-copro

The entire process that ends with the 15 second time out is fairly complicated...and annoying to the surgeons...which leads them to leave....which annoys me...because it affects my bottomline.

This is how it is supposed to work.

Surgeon MUST verify and MARK on the patient to confirm site of surgery BEFORE the patient can receive any type of sedation.

Meaning that MANY (and in my case MOST) patients CANNOT receive sedation for REGIONAL blocks...which can be uncomfortable....or wait until the surgeon marks the patients....if the surgeon has 2 rooms...and the GOOD and FAST surgeons always do.....

It defeats the purpose of the 2nd room because he can't call of the patient to go back until he marks the patient .

Oh...believe me...it isn't just a 15 second time out....the entire process is aimed directly at removing any semblance of efficiency.

If it added to patient safety...I'm all for it...but it doesn't.

If it doesn't hurt my bottomline and efficiency...then I don't care either...but it does.

 

[coprolalia]

The entire process that ends with the 15 second time out is fairly complicated...and annoying to the surgeons...which leads them to leave....which annoys me...because it affects my bottomline.

This is how it is supposed to work.

Surgeon MUST verify and MARK on the patient to confirm site of surgery BEFORE the patient can receive any type of sedation.

Meaning that MANY (and in my case MOST) patients CANNOT receive sedation for REGIONAL blocks...which can be uncomfortable....or wait until the surgeon marks the patients....if the surgeon has 2 rooms...and the GOOD and FAST surgeons always do.....

It defeats the purpose of the 2nd room because he can't call of the patient to go back until he marks the patient .

Oh...believe me...it isn't just a 15 second time out....the entire process is aimed directly at removing any semblance of efficiency.

If it added to patient safety...I'm all for it...but it doesn't.

If it doesn't hurt my bottomline and efficiency...then I don't care either...but it does.

Oh... I see. So, you're complaining about inefficiencies built into the system. People who've been empowered to affect your workflow, a systematic "lack of trust" in you as a professional I was complaining about
some time back. That someone who, just because there was a previous problem somewhere, has now been given authority to affect your workflow, whether or not it really makes a difference in what actually happens. You're complaining about the "loss of autonomy" and bureaucracy that affects the bottom line, namely subordinates enacting policy just because someone somewhere felt that you can't really be trusted and need to be double-checked... that it "sounds like a good idea" to have a check-and-balance in the system. Isn't that what this is really about and what provoked such a strong initial reaction from you?

Well, let me give you some of your own advice...

herein lies the problem...you consider yourself ABOVE this person who is just doing his job with POSITIONAL AUTHORITY over you.

...

It didn't roll "uphill"....it came down on you just like it will for the rest of your life...might as well get used to it..

... and I suggest you heed it so you don't get an ulcer. 😉

-copro

 

[militarymd]

Oh... I see. So, you're complaining about inefficiencies built into the system. People who've been empowered to affect your workflow, a systematic "lack of trust" in you as a professional I was complaining about
some time back. That someone who, just because there was a previous problem somewhere, has now been given authority to affect your workflow, whether or not it really makes a difference in what actually happens. You're complaining about the "loss of autonomy" and bureaucracy that affects the bottom line, namely subordinates enacting policy just because someone somewhere felt that you can't really be trusted and need to be double-checked... that it "sounds like a good idea" to have a check-and-balance in the system. Isn't that what this is really about and what provoked such a strong initial reaction from you?

Well, let me give you some of your own advice...



... and I suggest you heed it so you don't get an ulcer. 😉

-copro

You don't see the difference ...do you?

You're having a problem because it's about your EGO.


I'm having a problem because its about my WALLET.

You want to stroke your EGO.

I want to pad my WALLET.

 

[coprolalia]

You don't see the difference ...do you?

You're having a problem because it's about your EGO.


I'm having a problem because its about my WALLET.

You want to stroke your EGO.

I want to pad my WALLET.

Wait a minute! You said...

Being a doctor ain't what it used to be.....and in another 20 years...being a doctor will be no different than that loser wearing a funny hat saying, " you want fries with that lap chole?"

... and this isn't even just a little bit about ego? Maybe I (and everyone else) reading this thread is hearing something different. Your post reads exactly like my prior complaint. Namely, that some subordinate has been empowered to impede our workflow, and it costs us time and money to jump through their silly hoops, and that - most importantly - it doesn't really affect what happens anyway. Now, suddenly, this is about my ego and your wallet?

Give us a break, Mil. You're arguing my original point - precisely. Everyone else can decide who's being hypocritical here. And, besides you've repeatedly demonstrated on this forum that you're clearly not short on ego...

-copro

 

[jwk]

So Mil - what's the answer? How do you decrease wrong side/site surgeries?

 

[militarymd]

We have begun our slide down the slippery slope of losing physician autonomy and you guys don't even know it.

I'm hearing people say..."I'm getting used to it"

"it's ok with me"

10 years ago...if this was EVEN suggested....MD's would have said f uc k you and moved to make their millions somewhere else.



now....we say "sounds like a good idea"....while our income and autonomy continues to drop.

This is COMPLETE BU LL SH IT....and its our own fault.....

Being a doctor ain't what it used to be.....and in another 20 years...being a doctor will be no different than that loser wearing a funny hat saying, " you want fries with that lap chole?"

I don't see it the same as you...that's all.

 

[militarymd]

So Mil - what's the answer? How do you decrease wrong side/site surgeries?

It falls under the category...of SH IT happens....leave the doctors alone to take care of their patients...and if they fu ck up...they get sued...plain and simple.

From what I understand....the number of wrong site surgeries have not gone down.


On the other hand...drug testing have BUSTed a bunch of abusers who no longer get to practice ....so that they don't operate on the wrong leg when they're high.....making US look bad.

 

[Bertelman]

Here's a decent article consistent with what Mil is saying. Interesting idea, that the time out actually dilutes the responsibility, making no one ultimately responsible. Not the best resource, as it is a liability group, thus not representative of the nation as a whole. I doubt JCAHO would ever release data contradictory to its goals, though.

At the same time, reading the original JCAHO report, I didn't see any mention of drug use being a factor in any of the reported cases. Mostly communication issues. I think if anything, it is money and the bottom line that has created this problem. Surgeons, staff, etc. are driven to work faster than ever, squeeze more cases, etc. Leads to haphazard behavior.

I can't even remember which of my COPD'rs on a vent has the PNA v. CA. I could easily forget which leg to cut if I had 4 BKAs in one day.


**edit- fixed the link...stupid IE doesn't understand how to paste

 

[core0]

Here's a decent article consistent with what Mil is saying. Interesting idea, that the time out actually dilutes the responsibility, making no one ultimately responsible. Not the best resource, as it is a liability group, thus not representative of the nation as a whole. I doubt JCAHO would ever release data contradictory to its goals, though.

At the same time, reading the original JCAHO report, I didn't see any mention of drug use being a factor in any of the reported cases. Mostly communication issues. I think if anything, it is money and the bottom line that has created this problem. Surgeons, staff, etc. are driven to work faster than ever, squeeze more cases, etc. Leads to haphazard behavior.

I can't even remember which of my COPD'rs on a vent has the PNA v. CA. I could easily forget which leg to cut if I had 4 BKAs in one day.

You have an extra http at the beginning of the link. Otherwise interesting article. Unfortunately the suggestions there would not help with what Mil stated were the problems. If there is responsibility with one individual as suggested it would make things even slower.

David Carpenter, PA-C

 

[jwk]

You have an extra http at the beginning of the link. Otherwise interesting article. Unfortunately the suggestions there would not help with what Mil stated were the problems. If there is responsibility with one individual as suggested it would make things even slower.

David Carpenter, PA-C

Yet someone has to take responsibility - and in the end, it's still going to be the surgeon, although as it is now with the timeout protocols, everyone else will likely get dragged into it as well.