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Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: results of a national patient safety programme in the Netherlands
  1. Steffie M van Schoten1,
  2. Veerle Kop1,
  3. Carolien de Blok1,2,
  4. Peter Spreeuwenberg1,
  5. Peter P Groenewegen1,3,
  6. Cordula Wagner1,4
  1. 1NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  2. 2Faculty Economics and Business, Department Operations, University of Groningen, Groningen, The Netherlands
  3. 3Departments of Sociology and Human Geography, Utrecht University, Utrecht, The Netherlands
  4. 4Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Vrije Universiteit Medical Center (VUmc), Amsterdam, The Netherlands
  1. Correspondence to Steffie M van Schoten; s.vanschoten{at}


Objective To prevent wrong surgery, the WHO ‘Safe Surgery Checklist’ was introduced in 2008. The checklist comprises a time-out procedure (TOP): the final step before the start of the surgical procedure where the patient, surgical procedure and side/site are reviewed by the surgical team. The aim of this study is to evaluate the extent to which hospitals carry out the TOP before anaesthesia in the operating room, whether compliance has changed over time, and to determine factors that are associated with compliance.

Design Evaluation study involving observations.

Setting Operating rooms of 2 academic, 4 teaching and 12 general Dutch hospitals.

Participants A random selection was made from all adult patients scheduled for elective surgery on the day of the observation, preferably involving different surgeons and different procedures.

Results Mean compliance with the TOP was 71.3%. Large differences between hospitals were observed. No linear trend was found in compliance during the study period. Compliance at general and teaching hospitals was higher than at academic hospitals. Compliance decreased with the age of the patient, general surgery showed lower compliance in comparison with other specialties and compliance was higher when the team was focused on the TOP.

Conclusions Large differences in compliance with the TOP were observed between participating hospitals which can be attributed at least in part to the type of hospital, surgical specialty and patient characteristics. Hospitals do not comply consistently with national guidelines to prevent wrong surgery and further implementation as well as further research into non-compliance is needed.


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