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culating RN is connecting suction or an anesthesia provider is check-
ing the patient, they need to say they're not ready," she says. "During
the time out, team members should all have their attention directed at
the patient and procedure information being verified, preferably on a
white board or other visual display, such as a large monitor."
For Dr. Ring, the time out is sacred and essential. "I read the con-
sent word for word," he says. "Sometimes I'll be in the operating room
and the nurse starts the time out and I can't see the consent. I find
that unacceptable. I won't start the surgery without seeing the con-
sent, so I'll ask the nurse, she'll get it for me and we'll start up again."
In addition to the time out, Dr. Ring insists on both pre-operative
and post-operative huddles.
That's the right way to go, says Mr. Byrum: "I like to see the surgeon
lead the time out. That isn't happening in a lot of places right now. But
the surgeon is the one that has the ultimate responsibility for the safe-
ty of that patient, and is the one who's going to be making that deci-
sion and incision."
That level of commitment becomes a productive habit, says Dr.
Ring. "If you just go through the motions and aren't taking it seriously,
it can feel like a waste of time and become meaningless," he says.
"But if they feel meaningful to you, it really becomes an integral part
of the procedure to the point that you can't complete the procedure
without doing these things. It just doesn't feel right."
Site-marking: Choice or policy?
Nor does it feel right to Dr. Ring if he isn't cutting through his own ini-
tials when it comes time to do the incision. Though when it comes to
site-marking, that's his choice, not hospital policy.
"They still don't require ink exactly on the site you're operating on,"
he says. "I advocated for that, but they decided not to make it policy.
P R E - O P S A F E T Y
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