1. Pre-Induction Time Out
Lauren McLaughlin, DO
Tyler Morrissey, MD
Jacob Loyd, MD
Olivia Romano, MD
Jason Brainard, MD

2. Introduction
Currently, 3 of 4 training hospitals perform pre- induction timeouts
All members of the surgical team, anesthesia team, circulator, and scrub nurse involved
Goal to improve communication, quality, and safety
Concern for disrupting work flow, perform TO after anesthesia induction

3. Background
Concerns of preinduction TO include disruption of surgical work flow, delay of procedure start, patient anxiety
They found that preinduction TO allowed more time to correct equipment errors, obtain necessary blood products, and administer preoperative medications. No change in elapsed time to incision.
Another study found that not only was preincision work flow not disrupted, but there was a significant decrease in work-flow disruptions during the operation
Anxiety found not to be an issue in one study, appropriate pre- medications given, 65% of pts did not remember the TO, 29% remembered and felt reassured, 6% remembered and were indifferent
Preinduction TO can improve team communication and perception of improving safety. OR staff felt more actively involved with improving patient safety (95%), vs the rest of the hospital staff (55%)

4. Methodology
Institute Pre-Timeout Process trial for 2 weeks (Apr 3-14) using pre- made Timeout Sheets
PACU Resident would attend Timeouts, time process, instruct participants, and collect data.
Trial would occur in OR 9 (TACS) only
Same surgical residents for 2 weeks
Potentially unpredictable cases
Proximity to PACU
Trial would be difficult to implement and measure if attempted OR-wide

6. Pre-Induction Checklist
Circulator Nurse:
Introduce self
Verify consent, pt full name and MRN
Procedure and Laterality
Site Marked
Allergies
SCD’s applied
Post-op Dispo- home, floor, ICU?
Any concerns?

7. Scrub Tech:
Introduce self
Instruments available
Implants available
Equipment available
Supplies and suture per preference card
Any concerns?

8. Surgery:
Introduce self
Procedure and laterality
Patient position
Heparin?
Antibiotics ordered
T&S or T&C- units available
EBL estimate?
Any concerns?

9. Anesthesia:
Introduce self
Type of anesthesia- General, MAC, regional?
Confirm antibiotics
Anesthetic concerns?

10. Does this support team building?
RN- Yes or No
Scrub- Yes or No
Surgery- Yes or No
Anesthesia- Yes or No
Did this improve patient safety? 1=not at all, 3= somewhat, 5=absolutely
RN- 1  2  3  4  5
Scrub- 1  2  3  4  5
Surgery- 1  2  3  4  5  
Anesthesia- 1  2  3  4  5  
Did this change management?

12. Limitations Apr 10-14, TACS cases were limited
Surgery did not arrive in time for 3 timeouts
Pre-Induction timeout did not occur for ”unstable” patients
At discretion of PACU resident
PACU resident did not make it to all first case starts
Differences in answers depending on who was filling out questionnaire

13. Conclusion Successes: Areas to improve on: Improved team building
Increased patient safety
Areas to improve on:
Minimal effect on changing management
However this was possibly under-reported
Could be more time efficient with more familiarity

14. Conclusion How can we improve: Surgery team: Nursing team:
Increase compliance through improved communication and more advanced notice
Point out ways in which the pre-induction TO benefits them
2 minutes at the beginning could save 5-10 minutes later
Get surgical attending involved as an advocate, such as Dr. Meguid
Nursing team:
Outline expectations and educate OR nurses ahead of time
Focus on clear and expeditious pre-induction timeout process
Anesthesia team:
Take on a leadership role
Advocate for increased team building and communication
Highlight when pre-induction timeout changes management

15. Conclusion Future implementation
Successful rollout of pre-induction TO relies on overcoming the stigma that it is a waste of time
Work with surgical department on how to ensure compliance and cooperation
Focus on communication and education of all teams prior to implementation
Timeout whiteboard split into pre/post induction checklists may expedite and clarify process for all teams