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5/29/2023

Essential Concepts in Perioperative Huddles and Time Outs

Patient safety in the surgical setting continues to be an area of focus because of the significant patient harm resulting from surgical errors.  Many of these preventable errors result from poor communication between surgical team members.  The Joint Commission created the Universal Protocol to address errors in wrong-site, wrong-procedure, and wrong-person surgery, and the World Health Organization created guidelines and checklists for safe surgery.  One of the essential concepts is maintaining effective communication between team members starting from the pre-operative period and continuing through to the post-operative period.

The huddle is a commonly utilized process that promotes teamwork and prevents medical errors. The huddle brings together all team members to communicate information, coordinate care, and address any concerns.  As the primary provider, the surgeon leads the huddle but allows all team members to actively participate.  Huddles create an environment of safety, accountability, and empowerment so that all essential information is shared.  In surgery, huddles have also been shown to decrease equipment issues and increase the efficiency of the operating room.  Huddles should be performed pre-operatively, intra-operatively during the time-out process, and post-operatively as a surgical debrief. 

Patient safety starts before the patient enters the operating room.  Pre-operative huddles vary by institution; some are performed at the start of the operating day to review the planned cases, and others are performed prior to each surgery.  Pre-operative huddles should involve all team members, including the surgeons, anesthesia providers, nurses, operating room staff, and the patient. The content of the pre-operative huddle can vary, but the main goals are to make team introductions, confirm the patient’s identity, and verify the consent, procedure, and site marking.  Pre-operative huddles can also include checking the availability of necessary equipment, imaging, and resources prior to the start of the procedure.  Checklists are often used during the huddle to ensure that all essential information is communicated. The pre-operative huddle is also a time to address concerns from any team member and answer all questions prior to moving to the operating room. 

The time-out is performed in the operating room prior to the start of the invasive procedure or incision.  This process should actively involve all team members, ideally with an announcement of their name and role. It’s primary purpose is to confirm the patient’s identity, procedure, and site prior to the start of the operation.  Any remaining questions or concerns should be addressed at this time.

The post-operative huddle or debrief occurs at the conclusion of the surgery. The operating team members share important information about the procedure itself, any concerns or unanticipated events, and post-operative plans. This exchange encourages communication and empowerment of all team members.  In addition, since these huddles are performed after the procedure, they provide a unique opportunity to identify systems-based issues and areas for improvement.

Further Reading:

American College of Obstetricians and Gynecologists.  Patient Safety in the Surgical Environment. Committee Opinion No. 464. Obstet Gynecol 2010;116:786–90.

The Joint Commission. Universal protocol for preventing wrong site, wrong procedure, and wrong person surgery. Oakbrook Terrace (IL): Joint Commission; 2009. Available at:https://www.jointcommission.org/standards/universal-protocol/.

WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. Geneva: World Health Organization; 2009. PMID: 23762968. Retrieved from https://www.who.int/publications/i/item/9789241598552

Initial Publication May 2023.

 

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