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Surgical Site Signing and "Time Out": Issues of Compliance or Complacence

¹ Division of Orthopaedics, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada. E-mail address for G. Johnston: geoff.johnston{at}saskatoonhealthregion.ca

Investigation performed at the Saskatoon Health Region and the University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Methods: In the first study, performed in 2006, the presence of the initials of either the surgeon or the surgical resident in the draped surgical field was documented at the time of forty-eight procedures over a three-month period. In a second study, performed a year later, 231 randomly selected procedures were similarly evaluated, as was the performance of the newly adopted "time out" process.

Results: In the first study, after surgical field draping, the surgeon's initials were visible in 67% of emergent cases and 90% of elective cases. In the second study, the surgeon's initials were visible in 61% of emergent cases and 83% of elective cases. The "time out" was performed prior to the skin incision in 70% of the cases, was performed after the incision in 19%, and was not performed at all in 11%.

Conclusions: Orthopaedic surgeons should recognize the value of preoperative skin signing for all procedures and the additional value of the "time out" protocol. We recommend that surgeons strive for 100% compliance with both strategies.

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