128 - Stop, Collaborate, and Listen: The Surgical Count and Time-Out Remix

Description: Description of team
Ocean University Medical Center, a 23-operating-room acute care facility, undertook a quality improvement initiative to enhance the efficacy and standardization of surgical time-outs and counts. A frontline interprofessional team, composed of a registered nurse, a certified surgical technologist, a nurse practitioner, and a physician assistant, collaborated to update the facility's time-out and surgical count board. This project aimed to improve communication, enhance accuracy, and minimize the risk of retained surgical items.

Preparation and planning
A review of the existing time-out boards was conducted to identify areas for improvement and streamlining. This assessment considered current best practices, staff experiences, and potential enhancements to the process. Hospital time-out policies were also reviewed to ensure adherence to current protocols. Feedback was solicited from interprofessional team members to gain diverse perspectives and inform the redesign.

Assessment
Team members raised concerns about repetitiveness and the length of time-outs, as well as the lack of space and clarity on the surgical count boards. It was observed that time-outs were inconsistent with hospital policy and AORN guidelines. The fire safety portion was missing from the boards, and there was a discrepancy in how to perform the fire risk assessment. The surgical count boards were too small, forcing staff to write illegibly. A staff survey was devised to assess current perspectives and gather improvement ideas, which was supplemented by a review of AORN, The Joint Commission, and hospital policies.

Implementation
The team collaborated on a new design to combine the count and time-out board into one. The new surgical count board will be bigger for all surgical staff to see, clarifying initial counts and items added mid-case. Time-out boards will be condensed to increase focus on critical information. The design aims to create consistency between AORN, The Joint Commission, and hospital policies, especially for fire risk, to decrease staff confusion. Increasing the size of the count boards and moving their location will allow for better visualization and efficiency, particularly during change of shift.

Outcome
The project's success will be determined by post-implementation audits of time-out compliance, staff satisfaction surveys, and a review of safety event reporting data.

Implications for perioperative nursing
Implications of an unclear time-out board include rushed or incomplete safety checks. This initiative empowers nurses to advocate for safety over speed, reinforcing that a proper time-out should take less than 60 seconds. A standardized board with all required components from policy and AORN guidelines helps minimize errors and provides a visual tool for team collaboration. The Universal Protocol makes the nurse's role in verifying patient details and initiating the time-out non-delegable, requiring them to "stop the line" if discrepancies are found. As circulating nurses are accountable for the count process, an updated board is a critical tool for accuracy. It supports the AORN-mandated methodical count and empowers the nurse to halt procedures for count discrepancies until resolved per facility policy. This project provides nurses with a superior tool to fulfill their fundamental responsibility of preventing patient harm from wrong-site surgery and retained surgical items