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status, then move on with the new team."
There should also be special considerations given to high-risk proce-
dures, says Dr. Ring. "For very complex cases, there ought to be pro-
grammed intraoperative time outs. Some cases are very dangerous.
People lose a lot of blood. There's a high risk of medical problems.
There ought to be periodic time outs to say: How are we doing with
blood loss and fluid resuscitation? What are our labs? How's the surgery
going? Is it on schedule?"
Common sense? Of course, but that's not always enough.
"These are the kinds of ideas that people come up with," says Dr.
Ring. "But not everybody agrees with them, so they end up being guide-
lines instead of policy."
Dictator or coach?
At the University of Rochester Medical Center, Dr. Papadakos has
P R E - O P S A F E T Y
HOLD EVERYTHING Fully engaged time outs should be so integral to the
process that you don't feel comfortable doing procedures without them.
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