Development of Timeout Checklist for Skull Base Surgery

Introduction: A timeout is a preincision pause before surgery that is implemented to confirm a patient's identity, surgical site, procedure, and any safety concerns with the goal of preventing medical errors. In surgical settings, timeout related problems are the most common root cause that leads to adverse clinical outcomes. Generic timeout checklists may not provide the required specificity for skull base surgery and omit items that address issues specific to endoscopic endonasal skull base procedures.

Methodology: Current timeout practices for endoscopic endonasal skull base surgery were observed to assess compliance with the recommended timeout protocol for all surgeons at our institution and to identify additional items that are specific to skull base surgery. Participating surgeons, residents, and fellows were surveyed to identify additional items for exclusion and inclusion. Based on this information, a new timeout checklist specific to skull base surgery was created from the broader institutional timeout checklist and trialed in the operative setting. Surgeon feedback was used to further refine the checklist in an iterative process. Compliance with the revised skull base timeout is currently being tested in conjunction with a satisfaction survey.

Results: A survey of staff and faculty in the Department of Otolaryngology-Head and Neck Surgery showed considerable variation in compliance and utilization of the standard preoperative timeout checklist, demonstrating a need for a subspecialty specific timeout. Listed below is a revised skull base timeout that was developed in this study.

Revised skull base timeout:

• Surgeon announces timeout.

• All other activities immediately suspended.

• Patient name and date of birth.

• Procedure.

• Verify site, site laterality, and site marking.

• Overall plan.

• Allergies verified.

• Antibiotic prophylaxis.

• Imaging displayed and verified.

• Equipment or implants needed (e.g., Doppler, nerve stimulator, powered instrumentation, aneurysm clips, ICG fluoroscopy).

• Critical medications/drugs (e.g., steroids, adenosine).

• Anticipated blood loss or need for blood products, drugs (e.g., tranexamic acid, oxymetazoline, topical epinephrine).

• Carotid injury/vascular injury risk.

• Neuromonitoring.

• Mean arterial pressure goal.

• Research protocols.

• Likely duration.

• Postoperative plan.

• Other Concerns.

• Announces “everyone agrees.”

• Documented completion of timeout.

Conclusion: To be useful, a checklist must simultaneously capture subspecialty-specific key elements and promote compliance. Through observation of current practices, staff and physician satisfaction surveys, and an iterative process of field-testing, we have developed an operative timeout checklist that is compliant with institutional processes and specific to skull base surgery. Further refinement will be necessary as surgical practices evolve. This basic checklist also provides a framework for modification by other institutions performing skull base surgery.

 

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Artikel online veröffentlicht:
15. Februar 2022