Page 52 - Part 1 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

is an opportunity for all members of the team to share their

thoughts, which can set the proper tone — everyone in the
group is responsible for communicating. During this briefing,

everyone discusses what portion of the operation each will
perform and sets expectations for the rest of the procedure.

Often, aspects of the patient’s medical history are reviewed
that may have been somewhat unrelated to the operation to be

performed, yet may be vital to the anesthesiologist and other
members of the team.

When done well, these time-outs reflect a patient-centered

safety culture and develop an environment of trust in staff who
feel empowered to report patient safety events without fear

of reprisal, while acknowledging that humans are fallible and
make mistakes. Team communication in the surgery suite is a

necessity as it is extremely rare that only one provider is sued
when an error occurs. Everyone in the room is a prospective

co-defendant. Therefore, everyone present needs to be “on the
same page”.

During the time-out, the team comes together and develops
a shared mental model of what the procedure will be like,

increasing the chances that all members will have the situational
awareness needed to prevent harm. It also establishes the

leadership of the team and empowers all members to work
on behalf of the patient. Administration of drugs, control

of glycemia, allergies, and other factors that can affect an
operation’s outcome are discussed in these briefings.

Despite the progress in time-out implementation, 104 sentinel

events involving the wrong patient, wrong site, or wrong
procedure were reported in 2016, according to data from The

Joint Commission, making them the second-most reported

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