Introduction: The timeout (TO) can prevent adverse events but is subject to TO engagement. We hypothesize transforming the TO to an auditable, active process will improve compliance and engagement. Methods: The passive nature of the current TO was identified as a potential safety issue on staff patient safety culture surveys. Subsequently, the Time Out Engagement and Standardization (TOES) quality improvement initiative was developed. 11 TOs were audited concerning engagement and content. Leadership and frontline stakeholders were engaged as members of the TOES team to determine potential interventions. A TO consisting of 15 elements utilizing a TO whiteboard with role specific objectives was developed. Plan, Do, Study, Act (PDSA) cycles commenced. Following implementation, 17 TOs in urology, general surgery, and vascular surgery were audited based on engagement and content. Results: Engagement varied with nurse participating in 100% compared to anesthesia provider or surgeon participating in 18%. No TO included all 15 elements and only 13% of elements were standardized across TOs. Overall, 40% of the elements were discussed in 80% of TOs. Post-implementation of TOES, nursing, anesthesia, and surgeon participated in 100% of TOs. The 15 standardized elements of the TO were discussed 90% of the time. Voice of the customer audits revealed widespread acceptance of the active TO. Within the robotic OR, urologists noted a particular improvement in preoperative planning communication across the surgical team. Conclusions: We identified a need for increased engagement of the TO based on staff concerns which were verified through auditing. Implementation of a team driven intervention and rapid PDSA cycles led to measurable improvement of the surgical TO. SOURCE OF Funding: None
