Why isn't 'time out' being implemented? An exploratory study
Open accessAbstract
BACKGROUND: While there has been much discussion extolling the virtues of using 'time out' as a means of preventing the potential for sentinel events, to date there has been little examination of the issues that impact on clinicians' uptake of 'time out' in operating-room settings. AIM: This study sought to methodically identify implementation and practice issues associated with the introduction and ongoing use of a 'time out' protocol in a large healthcare organisation. METHODS: Sixteen participants were interviewed and included surgeons, anaesthetists, nurse managers and nurses who worked at the clinical interface. Textual data were analysed using a grounded theory approach, identifying subcategories to illustrate causal relationships to the category. RESULTS: The category 'ambivalent compliance with "time out"' was the central idea that was recognised by events and behaviours that surrounded the introduction of 'time out.' Subcategories included haphazard implementation of time out, hierarchical team culture and tribal affiliations of members, and clashing clinical priorities make it difficult to incorporate 'time out' into practice, and led to 'ambivalent compliance.' CONCLUSION: There is little doubt that using a 'time out' protocol in the operating room allows team members to share explicit confirmation of safety-related details. However, when introducing patient safety initiatives into practice, recognising compliance issues is an important first step towards identifying ways in which to address them.
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In surgical teams, rigid professional roles and a hierarchical team culture constrained open discussion and created contention over how and when a 'time-out' should be completed, resulting in inconsistent use and poor fidelity.
“Similarly, in surgical teams, rigid professional roles and a hierarchical team culture constrained open discussion and created contention over how and when a “time-out” should be completed, resulting in inconsistent use and poor fidelity [50, 53].”
From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [50]
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Implementation of safety checklists in surgery: a realist synthesis of evidence
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BackgroundSelf-citationMcGuier, E. A., Kolko, D. J., Aarons, G. A., Schachter, A., Klem, M. L., Diabes, M. A., Weingart, L. R., Salas, E., & Wolk, C. B. (2024) · Implementation Science · doi:10.1186/s13012-024-01381-9 · Cited by 70 · see citing works
- Authors
- Gillespie, B. M., Chaboyer, W., Wallis, M., & Fenwick, C.
- Affiliations
- Griffith University (AU)
- Corresponding author
- Gillespie, B. M.
- Venue
- Quality and Safety in Health Care
- Publisher
- BMJ
- Published
- 2010-03-08
- Volume
- 19
- Issue
- 2
- Pages
- 103-106
- ISSN
- 1475-3898 (ISSN-L)
- 1475-3901
- OpenAlex
- W2107823593
- Cited by
- 51
- References
- 15
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2022: 2 · 2020: 2 · 2019: 4 · 2018: 7 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 1 · 2013: 6 · 2012: 5
- FWCI
- 7.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- Griffith University
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- surgical time-out, patient safety, sentinel events, implementation barriers, surgical workforce, clinical priorities, safety procedures
- MeSH terms
- Attitude of Health Personnel, Communication, Humans, Interviews as Topic, Operating Rooms, Patient Care Team, Systems Analysis, Organizational Culture
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