Safety briefing held before any incision is made

The preoperative safety briefing in use at Kaiser Permanente hospitals always is held before any incision is made, but other than that direction, Kaiser leaves it up to individual hospitals to determine when to do it. The Anaheim facility conducted briefings after anesthesia was introduced, but some others are doing it with the patient awake.

Douglas Bonacum, MBA, vice president of safety management with Kaiser Permanente in Oakland, CA, notes that the latter method can involve the patient in the conversation, which is consistent with trends toward more patient involvement in their care.

The surgeon should lead the process, he says, because his or her position as captain of the ship gives the briefing credibility. As the team is finalizing preparations for the surgery, the surgeon gets everyone's attention and calls for a preoperative briefing. The surgeon usually begins by summarizing the case, identifying the patient by name, and stating what procedure will be one, what technique will be used, where the operative site is, and any other information that might be useful.

"Then he or she will turn to the anesthesiologist and ask for similar input, and then probably the scrub nurse, and so on around the room," Bonacum says. "This usually takes just a couple minutes total, though they can take as long as necessary if an issue comes up that needs to be discussed."

Kaiser already was developing its preoperative safety briefings when the Joint Commission on Accreditation of Healthcare Organizations started requiring a "timeout" before surgeries to verify key information. The Joint Commission timeout calls for teams to stop all work for a moment and confirm that they have the right patient and are about to do the right procedure at the right site.

Bonacum explains that the preoperative safety briefings should count as complying with the Joint Commission requirement, but they go beyond that. The preoperative safety briefings help teams avoid wrong-site surgery, but they are more expansive in their potential to improve the surgery overall, he says.

"We recommend you incorporate the time out into the briefing, to actually say during the briefing that you're having the timeout," Bonacum says. "That ensures that you are complying with the Joint Commission requirement, and the rest of the briefing goes on beyond that."