Increasing patient safety and surgical team communication by using a count/time out board.

Communication and collaboration in patient care settings is vital for promoting the best possible patient outcomes. The counting of sponges, sharps, and instruments, and the surgical time out before the start of any surgical procedure are opportunities for the surgical team to address patient safety risks. Personnel in the surgical services department at St Luke's Episcopal Hospital, Houston, Texas, implemented the use of a hanging, magnetic, dry-erase board that includes the elements of a time out (eg, patient name and identifiers, procedure, site, allergies) and provides a means to document countable items. The board promotes team awareness of this time out and count information at all times during a procedure. Specific magnets on the count board identify items intentionally packed inside the patient to remind the team of the location of these items when the count is reconciled at the end of the procedure. In addition, a process of obtaining an radiograph of items similar to any missing items assists radiologists in identifying the location of retained surgical items. As a result of implementing both changes, our ability to locate missing items has significantly increased.