Is a second time-out required if a patient is having two procedures or can the OR team confirm all of the procedures at one time?

Whenever there is more than one procedure being performed by separate procedure teams, there needs to be a time-out prior to each team beginning their procedure. This does not apply when the same team is performing multiple components during a single procedure.

There may be situations when hospital policy or law/regulation requires two (2) separate consents, i.e., Cesarean section and tubal ligation.  Two separate time-outs should occur for these situations. In all other circumstances, each organization may define when more than one time-out must be performed.

Time-out is addressed in the Universal Protocol.  UP.01.03.01 states a time-out is performed before a procedure.  Time-out is performed to verify the correct patient, correct procedure and correct site.

The Elements of Performance for UP.01.03.01 state:

• Time-out is performed before starting the invasive procedure or before incision
  
• The procedure team conducts the time-out. The procedure team consists of:

o Individual performing the procedure
o Anesthesiology provider
o Circulating RN
o Scrub technician
o Others who will be participating in the procedure from the beginning.

• When two (2) or more procedures are being performed on the same patient, and the individual performing the procedure changes, a time-out is performed before each procedure is initiated.
  
• During the time-out, the procedure team must agree, at a minimum, on the following: correct patient, correct site, correct procedure. Any discrepancies must be resolved before proceeding with the procedure.
  
• The completion of the time-out must be documented in the patient's medical record. Healthcare organizations determine the amount and type of documentation.

References:

The Joint Commission Universal Protocol

AORN Correct Site Surgery Tool Kit

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