Authors: (including presenting author): :
Hung SK(1)
Affiliation: :
(1)The Department of Anaesthesiology & Perioperative Medicine, Hong Kong Children's Hospital
Keyword 2: :
Patient Safety
Keyword 3: :
Clinical Audit
Keyword 4: :
Multidisciplinary Teamwork
Introduction: :
The surgical Time-Out is a critical safety intervention designed to prevent wrong-patient, wrong-site and wrong-procedure events. Although routinely implemented, its effectiveness depends on deliberate pause, multidisciplinary engagement, and consistent verification of high-risk elements. This project reports a prospective observational audit of the Time-Out process in operating theatres, followed by targeted staff briefing and education, and a subsequent surprise check to evaluate sustainability of safe practice.
Objectives: :
The objectives were to observe real-world Time-Out practices across different surgical specialties, identify good practices and areas for improvement, and assess whether focused staff education could enhance compliance. Particular emphasis was placed on site marking verification, consent confirmation, and team communication.
Methodology: :
A prospective observational audit was conducted in operating theatres between May and November 2025. Fifty surgical procedures were observed using a standardized Time-Out audit tool. Observations included patient identification, procedure type and specialty, site marking checks, confirmation of relevant alerts, blood typing and cross-matching readiness, availability of blood products, and readiness of special equipment or implants. Contributing factors to unsafe practices, such as time pressure, role ambiguity, and incomplete team participation, were documented. Based on audit findings, targeted briefing and education were provided to all operating theatre staff. A surprise check was subsequently conducted without prior notice to assess real-time compliance.
Result & Outcome: :
Results: Initial audit findings demonstrated strong compliance in signed consent being read aloud (98%) and confirmation of relevant alerts (95%). Lower compliance was observed in blood readiness (88.9%), availability of blood products (94.1%), and verification of special equipment or implants (88.9%). These gaps were commonly associated with assumptions that checks had been completed earlier in the workflow and lack of a deliberate pause during Time-Out. Following staff briefing and education, the surprise check demonstrated overall improvement across most elements, particularly in blood and equipment checks, indicating improved vigilance and shared situational awareness. However, a 10% failure rate in consent verification was identified. Further analysis suggested that consent confirmation was sometimes assumed to have been completed during the Sign-In process, and that junior nursing staff were hesitant to initiate or coordinate Time-Out involving all parties. Conclusion: This audit demonstrates that while targeted education improves compliance, sustained surgical safety requires continuous monitoring, regular measurement, and reinforcement. Consent must be jointly confirmed by the surgeon, anaesthetist, and nurse during Time-Out and should not be replaced by earlier checks. Empowering junior nursing staff to confidently initiate the process and maintaining regular refresher training are essential to sustaining a high-reliability surgical safety culture.
