3 Time Out Policy: Correct Patient, Correct Procedure, Correct Site

Abstract

The Joint Commission defines a time out procedure as an immediate pause by the entire surgical team to confirm the correct patient, procedure, and site. First introduced in 2003, the time out was initially viewed as a safety measure to prevent harm as a result of operating on the wrong patient or the wrong site or performing the wrong procedure. This same procedure is applied in the dental setting to decrease the incidence of preventable mishaps such as extracting the wrong tooth. During the time out, the dental team pauses, gathers together, and discusses what the proposed procedure will be, increasing the chances that all team members will have the situational awareness needed to prevent injury or missteps. It also establishes the leadership of the team and empowers all members to work on behalf of the patient. This includes a deliberate pause in activity involving clear communication among all members of the dental treatment team. The procedure is not started until any questions or concerns are resolved. The time out includes verifying the correct patient identity, correct procedure verified with consent, correct site (tooth) and side, and availability of any special instruments or equipment needed. A review of the patient’s medications, pertinent drug allergies, and other factors that can affect a procedure’s outcome are discussed in these briefings. When practiced in this step-by-step manner, with involvement of all members of the dental team led by the dentist, time outs can be extremely effective and can contribute to improved patient outcomes. When done effectively, time outs reflect a patient-centered safety culture and develop an environment of trust in dental team staff.

Verification Process Policy

  • One of the most common reasons why patients engage in lawsuits against dentists is extraction of the wrong tooth.

  • This is a preventable occurrence that often occurs as a result of haste or inattention.

  • A “time out” is an opportunity for the dental team to pause and eliminate errors before the treatment begins.

Correct Site Surgery and Time Out Procedure

  • Removal of the wrong tooth is a preventable error.

  • It represents 10 to 15% of claims in the past 15 years.

  • Nearly 50% of claims are settled “no contest.”

  • Cases are often indefensible because they are typically considered preventable.

  • Wrong tooth extractions represent a large outlay in claims, i.e., in dollars.

    • An average of $1,500,000 per year over the past 10 years.

  • Wrong tooth extractions can lead to a loss of rapport with patients and colleague dentists.

Replacing Risky Habits with Safer Habits

  • Implement a “time out” procedure prior to performing the surgery.

    • It enables the provider to check and verify documentation.

    • It also enables the provider to confirm the following:

      • Correct patient.

      • Correct procedure.

      • Correct site.

Time Out Procedure

  • Before the procedure is started, the treatment team pauses to review documentation for the patient identity, procedure, and site.

  • If any disparities are encountered, appropriate calls are made and documented prior to the start of the procedure.

  • If the disparity cannot be resolved, the procedure is deferred to another time.

EXTRACT: Acronym to Prevent Wrong Tooth Extractions

  • Examination: should be independent of the referral doctor’s examination and preferably at a separate preoperative consultation appointment.

  • X-ray check: current and diagnostic; correct patient and spatial orientation.

  • Treatment plan: does the treatment plan correspond with the referring doctor’s?

  • Review: chart review preoperatively in advance of the procedure.

  • Announce: current plan with the “time out” procedure.

  • Count: the teeth; the first tooth count during the “time out.”

  • Treat: beginning the surgery with a second tooth count.

E: Examination

  • It should be independent of the referral doctor’s examination and preferably at a separate preoperative consultation appointment.

  • Perform an additional clinical and radiographic examination.

  • Consultation visit—why it is required?

    • To establish an independent diagnosis.

    • To verify accuracy of the referral.

    • To review medical history in advance of procedure.

    • To consult with the patient’s physician if indicated.

    • To review the surgery with the patient (or guardian) when the patient is not premedicated.

    • To make financial arrangements prior to the day of the procedure.

    • To verify insurance benefits/preauthorization.

    • To meet the patient so that he/she is no more a “stranger.”

  • Without a prior, separate consultation appointment, it is imperative that the office protocols be monitored much more closely on the day of the procedure.

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Dec 8, 2021 | Posted by in General Dentistry | Comments Off on 3 Time Out Policy: Correct Patient, Correct Procedure, Correct Site

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