The aim of this study was to prospectively assess the results of a preoperative surgical safety checklist by comparing the initial phase of implementation of the Time Out Procedure (TOP) to the results four years later. We compared the accuracy and acceptance of the TOP to determine whether surgical practice had changed.

The TOP was initiated for all elective surgical procedures performed in Christchurch in 2004. An initial audit from September 2004 – April 2005 (Phase 1) was compared to one from October 2008-September 2009 (Phase 2) looking for an improvement in completion of the procedure. Variances were recorded and analysed within the categories of 1 System and process 2 Consent and limb marking 3Incorrect details and 4 Near miss. A questionnaire was also sent to all the surgeons to determine their attitude towards the TOP.

Although the TOP was completed more often in Phase 2 (98%, p<0.001) there were more variances (9%, p<0.001). The commonest variance was due to the surgeon and assistant not being present at the TOP which was significantly worse than in Phase 1 (p<0.0001). The results of the surgeon questionaire showed that only 88% agreed that the TOP was valuable in preventing wrong site surgery.

This surgical indifference to the TOP is difficult to explain especially when National and International agencies have stressed its role in preventing surgical error. The recent introduction of the expanded WHO Checklist should be ‘surgeon led’ to be effective.

The purpose of this paper is to review the first six months experience of using the ‘Time Out’ procedure to avoid wrong site/side surgery and to evaluate the usefulness of this procedure in the routine preoperative check.

Over a period of 18 months all elective surgical hospitals in Christchurch (both private and public) have coordinated to develop a pre-operative ‘Time Out’ check list to ensure that the correct surgical procedure is performed on the correct site. This procedure involves a final check of patient details, including surgical procedure and site, immediately prior to surgical preparation of the operative site.

All forms during this six month period were prospectively collected and evaluated, specifically looking for system errors, which could proceed to wrong site surgery.

There were a total of 10,330 procedures performed during this period within the three hospitals of which 9,098 (87.2%) completed time out forms were returned.

There were no wrong side or wrong site surgeries performed during this six month period. However, there were three ‘near miss’ situations which were captured by the time out procedure.

Analysis of the time out forms also revealed numerous consent issues, incorrect documentation and systems errors which could potentially have lead to serious errors in management and which will be discussed in detail.

During this period there were 109 objections (1.2%) to the time out procedure.

The time out procedure has been shown to be a useful tool for avoiding wrong site/side surgery and has gained acceptance amongst both medical and nursing staff as being a valuable check prior to surgery. It has accentuated the collective team responsibility for determining the correct site and side of surgery and as such is recommended for use in all centres to eliminate system errors resulting in incorrect site/side surgery.