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The 'time-out' procedure: an institutional ethnography of how it is conducted in actual clinical practice
journal contribution
posted on 2013-08-01, 00:00 authored by S Braaf, Elizabeth ManiasElizabeth Manias, R RileyBACKGROUND: The time-out procedure is a critically important communication interaction for the preservation of patient safety in the surgical setting. While previous research has examined influences shaping the time-out procedure, limited information exists on how actual time-out communication is performed by multidisciplinary surgical team members in the clinical environment. METHODS: An institutional ethnographic study was undertaken. The study was conducted over three hospital sites in Melbourne, Australia. In total, 125 healthcare professionals from the disciplines of surgery, anaesthesia and nursing participated in the study. Data were generated through 350 h of observation, two focus groups and 20 semi-structured interviews. An institutional ethnographic analysis was undertaken. RESULTS: Analysis revealed healthcare professionals adapted the content, timing and number of team members involved in the time-out procedure to meet the demands of the theatre environment. Habitually, the time-out procedure was partially completed, conducted after surgery had commenced and involved only a few members of the surgical team. Communication was restricted and stifled by asynchronous workflows, time restrictions, a hierarchical culture and disinclination by surgeons and anaesthetists to volunteer information and openly communicate with each other and nurses. Healthcare professionals became normalised to performing an abbreviated time-out procedure. CONCLUSIONS: Patient safety was relegated in importance as productivity, professional and hierarchical discourses configured the communication practices of surgical team members to limit active, open and direct communication. Examining how the time-out procedure was conducted in the clinical environment enables possibilities to emerge for facilitating compliance with hospital and WHO guidelines.
History
Journal
BMJ Quality & safetyVolume
22Issue
8Pagination
647 - 655Publisher
BMJ GroupLocation
London, Eng.Publisher DOI
ISSN
2044-5415eISSN
2044-5423Language
engPublication classification
C1.1 Refereed article in a scholarly journal; C Journal articleCopyright notice
2013, BMJ Publishing GroupUsage metrics
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No categories selectedKeywords
CommunicationQualitative researchSafety cultureSurgeryAdolescentAdultAnesthesiologyFemaleFocus GroupsGeneral SurgeryGuideline AdherenceHumansInterdisciplinary CommunicationMaleMedical ErrorsMiddle AgedOperating Room NursingOperating RoomsOrganizational PolicyPatient SafetyVictoriaYoung AdultScience & TechnologyLife Sciences & BiomedicineHealth Care Sciences & ServicesHealth Policy & ServicesSURGICAL SAFETY CHECKLISTOPERATING-ROOMFAILURESNURSES
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