Time Out

Checklists such as the Universal Protocol for Preventing Wrong Patient, Wrong Procedure, Wrong Site Surgery (AKA "Time Out") have been proven to decrease communication failures, malpractice claims, complications and mortality. Is the Universal Protocol universally followed? Documentation can be reviewed for completeness, but only direct observation can truly determine compliance. Direct observation is difficult, however, due to the Hawthorne effect (when those that are being audited change their behavior because they are being observed). Self-reported compliance can also be biased. A recent study at Vanderbilt used medical students as observers, where the OR staff was not aware they were being evaluated, and compliance was found to be only 78% for all core items. Strict adherence to Time Out is likely lower than a checklist completion indicates.