Implications for Patient and Provider Safety
The origins of the surgical time-out can be traced back to safety checklists used in the aeronautic industry9. The philosophy of usage influences how timeouts or checklists are conducted10. A procedural time-out may function as a to-do list or as a backup process to verify tasks completed from memory. The time-out is designed to protect against errors from memory recall. There is usually a component of mutual redundancy in conducting a time-out as multiple team members can monitor each other’s responses10. Taking cues from other high reliability organizations, the World Health Organization designed a surgical safety checklist which resulted in reducing patient morbidity, mortality, and complication rates11,12. In the setting of the COVID-19 pandemic, several academic organizations have released guidelines on performing a tracheostomy. These recommendations are aimed at safety measures to mitigate transmission risk of SARS-CoV-2. Given the potential consequences for error, these standardized operating practices for tracheostomy should not be carried out simply from memory recall. Use of a dedicated tracheostomy time-out will allow for safety measures to be verified in a consistent manner. There are several key advantages to using the tracheostomy time-out: review of critical steps by multiple team members, improvement in communication between OR personnel, and an emphasis on quality control. Disadvantages include possible time delays and checklist fatigue. In order to address this, we have made the tracheostomy time-out focused and concise. If performed without interruptions, the time-out can be completed in under 1 minute.