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Improving Team Performance During the Preprocedure Time-Out in Pediatric Interventional Radiology

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Background: The preprocedure time-out is a high-profile safety measure, and compliance is coming under increasing scrutiny. A checklist-based scoring system was developed to rigorously assess compliance, and a system of video monitoring and feedback was used to track performance and improve the time-out process in pediatric interventional radiology.

Methods: A time-out "script" containing a series of observable behaviors to be performed collectively by the physician, nurse, and technologist before each interventional procedure was used to create a checklist. A procedure room equipped with an audio/video recording system allowed capture of time-outs for later review. The reviewer scored one or two time-outs each week, and the results were posted to provide feedback.

Results: The process of continual feedback and modification led to substantial improvements in time-out performance during a three-year period. Analysis of subscores revealed common failure modes that were subsequently addressed. The scoring checklist was also modified after analysis suggested redundant or unnecessary items. Gains were noted in the efficiency of the time-out protocol, which took more than 1 minute in the initial stages but soon shortened to 30–45 seconds as the team gained experience. Assessment of scoring consistency across three independent observers revealed 93% interobserver agreement and 95% intraobserver agreement. Clarification of the scoring criteria led to improved consistency (97% and 98% inter- and intraobserver agreement, respectively).

Conclusions: The combination of a time-out checklist, recorded procedures, review, and feedback produced not only improvements in time-out performance but also improvements in the scoring system and time-out process.

Document Type: Research Article

Publication date: September 1, 2012

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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