How We Really WHO: Assessing Completeness, Team Engagement, Distractions and Authority Gradient During 'Time Out' Component of WHO Safer Surgery Checklist.

Background: Anecdotal experience suggests that WHO Safer Surgery Checklist has become a 'tickbox' exercise, resulting in variable team engagement and efficacy.

Aims: To observe the quality and completeness of 'Time Out', together with the level of team engagement during obstetrics and gynaecology procedures.

Materials and methods: Observational study where the following data were collected during 'Time Out': % of the 19 items correctly responded to after 'challenge'. Type and duration of distractions. Level of team engagement. Authority gradient and likelihood of speaking up (Visual Analogue Score).

Results: Data from 70 obstetrics and gynaecology cases were collected over 8 weeks. 'Time Out' was clearly announced in 91.4% and was performed in all cases but not all items were communicated in the correct 'challenge and response' manner. Mean percentage of questions appropriately 'challenged' and 'responded' to was 92% ± 6.86%. Mean duration of 'Time Out' was 92.01 ± 86.9 s and observed distractions were auditory (61%), visual (26%), irrelevant chatter (22.5%) and theatre traffic (13%). In 92.8%, at least two team members were not engaged and were performing non-essential tasks. The likelihood of a team member being able to 'speak up' was 8.78/10 (±0.71) and this appeared independent of whether it was led by nurses, doctors, operating department practitioners or healthcare support workers.

Conclusion: Although performed in all cases, 'Time Out' is often not clearly announced or completed in the correct 'challenge and response' manner. It is plagued by avoidable distractions and suboptimal team engagement. Greater awareness is crucial to ensure more complete team involvement.