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Sana Qureshi, Emily Chang, Moshiur Rahman, Jennifer Weizer; Physician Compliance with Time-outs for Clinic Procedures: A Plan-Do-Study-Act Initiative. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1597.
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Patient verification is a basic tenet of safe healthcare delivery. Patient misidentification has been revealed as a root cause of many medical errors. Physicians performing procedures in a clinical setting should use time-out checklists to verify each patient and procedure, but no such widely accepted checklist exists for this in ophthalmology. We aimed to assess and improve adherence to a 6-point clinic procedure time-out checklist at the University of Michigan Department of Ophthalmology.
80 ophthalmology attendings and 32 residents and fellows at 4 different sites participated. A 6-point time-out checklist for procedures was devised; consisting of confirming patient name, birthdate, procedure name, correct eye, procedure plan from clinic notes, as well as correct eye initialing. Individual adherence to the checklist was audited by an impartial observer who gave immediate feedback. For non-procedural physicians, 2-point verification confirming patient name and birthdate was audited for clinic visits. Baseline data to determine level of adherence was collected from 8/1/17-3/31/18. On 4/1/18 results were shared with the physicians, and interventions consisting of physician education and visual aids were implemented. Post-intervention data was collected from 4/2/18 to 10/15/18. A second “adjustment” with reports presented via email, conferences and faculty meetings was initiated on 12/1/18. Post-adjustment performance data was collected from 1/1/19-7/18/19. We recorded the “perfect score” rate: the frequency at which providers correctly completed all measures for each phase of the study.
For the 6-point procedure checklist, the “perfect score” rate at baseline, post-intervention, and post-adjustment was 87.9%, 92.7%, and 94.9% respectively. Increased compliance was seen in confirmation of birthdate, previous note procedure plan, procedure verification, and eye initialing. Two-point verification of patient name and birthdate in the clinical setting improved from 87.9% at baseline to 100% at both post-intervention and post-adjustment phases.
Eye care providers at the University of Michigan displayed continued improvement in adherence to time-out checklists for clinic procedures throughout the study period. Implementation of interventions helped to increase compliance rates to 100% for most checklist components.
This is a 2020 ARVO Annual Meeting abstract.
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