Strabismus surgical time-out: an illustrated whiteboard modification

Abstract Background Errors in strabismus surgery—including wrong eye, wrong muscle, and wrong procedure—can occur when there is confusion about the surgical plan among members of the surgical team, including surgeons, anesthesia staff, nurses, and technicians. The purpose of this study was to assess whether implementation of a strabismus-specific whiteboard combined with oral statement of the surgical plan using nonophthalmological terminology could improve communication among the team before commencement of surgery. Methods A strabismus-specific whiteboard with labeled diagram of the eyes and extraocular muscles was designed. Patient identifiers, diagnosis, deviation, and procedure name were included. This whiteboard was completed preoperatively and referenced during time-out. The surgeons and operating room staff were trained in its use, and surveys were completed before and 6 months after implementation of the whiteboard time-out. Results The pre-implementation survey was completed by 19 operating room staff members, of whom 15 completed the post-implementation survey. The strabismus specific whiteboard increased staff member understanding of procedure laterality (74% to 93%), muscle(s) to be operated (37% to 93%), and specific procedure(s) planned (37% to 87%). Surgeon surveys also showed increased confidence in staff member understanding of each parameter with whiteboard use. Conclusions A standardized time-out combined with an illustrated strabismus surgery whiteboard improves communication between team members and has the potential to reduce surgical errors.