• The anesthesia provider relays the patient's ASA class and alerts the
team of potential anesthesia-related problems during the case.
• The surgical technologist confirms that the sterile indicators are
good and that she doesn't anticipate any equipment-related problems.
• The surgeon always speaks last to confirm the procedure, tells the
team how long the case should last and discusses the potential for
complications. The one scripted line every surgeon must say before
cutting: "If anyone at any time sees something abnormal during this
case, please speak up."
It might seem like a waste of time to have members of the surgical
team introduce themselves before every case, especially if you work
in a small center with a close-knit crew. But the pre-op introductions
are important, even when everyone knows one another. That small
gesture serves as an icebreaker and ensures every member of the
team is engaged in the procedure and actively involved in the check-
list process. Plus, studies have shown that someone who talks during
the pre-op time out is more likely to speak up during the procedure if
something seems amiss.
Monitor real-time compliance
Surgeons should lead the pre-op time out, but you should also
assign a leader in the OR who's responsible for ensuring the surgical
team covers every element of the checklist — and prevents surgery
from commencing until they do. The anesthesia provider is well suited
to fill that role. When the incision is about to be made and the check-
list should be completed, they're done putting the patient to sleep and
can direct their full attention to the time out. The surgeon drives the
process, but the anesthesia provider ensures everyone is participating
and all the elements of the checklist are covered.
4
Safety
S
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