Use of "Time-Out" checklist in interventional radiology procedures as a tool to enhance patient safety

This study was done to evaluate the feasibility and effectiveness of adopting a safety checklist (SC) in the angiography suite during interventional radiology (IR) procedures to enhance patient safety. Surgical SC was successfully introduced in 2009 with the aim of drastically reducing the morbidity and mortality caused by human error on patients during their stay in the operating room. Even CIRSE, the Cardiovascular and Interventional Radiological Society of Europe, recently published its own SC recommending its use in IR suites. Since January 2012, in our routine practice in the angiographic unit, we have used a 20-item checklist named "Time-Out" derived from the CIRSE SC. The main items are: in the Time-Out phase, active verbal communication within the team; correct identification of the patient and of the procedure site and side. Additionally, during the preprocedure (Sign-In) and postprocedure (Sign-Out) stages a series of clinical data are collected such as administration of prophylaxis against contrast allergy or contrast-induced nephropathy (CIN), when needed informed consent, discontinuation of anticoagulation therapy, fasting, correct labelling of biological samples, etc. Preliminary educational sessions were held to sensitise all the staff involved in the Time-Out project (physicians, nurses, radiographers) and ensure satisfactory compliance from the outset in consideration of the increased time and paperwork that checklist implementation would involve. The use of a checklist in IR, named "Time-Out" in our experience was feasible and effective allowing elimination of adverse events in the first year of use and promoting significant involvement and awareness of patient safety among the health-care team. The level of implementation, completeness and acceptability of the SC within the team increased after adequate training had been provided.