Surgical Site / Timeout Survey Results


The American Society of Pediatric Otolaryngology (ASPO) Ad Hoc Patient Quality and Safety Committee was created in May, 2009 to address issues relating to current and future practice standards. The committee is co-chaired by Craig Derkay and Ellen Deutsch and members include Dave Roberson, Ellis Arjmand, and Steve Sobol. ASPO President Sukgi Choi has also assigned Rich Rosenfeld and Rahul Shah to the committee as consultants.

The first project tackled by the committee was to assess the current operative protocols at various facilities where pediatric otolaryngology procedures are performed, including university hospitals, community hospitals, pediatric-only ambulatory surgery centers, and comprehensive surgery centers that take care of children. Practicing ASPO members and OR Directors of the CHCA (Child Health Corporation of America) Hospitals were surveyed regarding surgical time-out, site marking and surgical checklist protocols for routine pediatric otolaryngology procedures.  The data are summarized below.

  1. For bilateral placement of ventilation tubes, adenotonsillar surgery, airway endoscopy, and nasal surgery, most respondents who operate at children’s hospitals report hospital policies which do not require site marking; time out procedures are considered sufficient (Table 1).   For “obvious” surgical sites (such as a neck abscess) 76.9% of respondents who operate at children’s hospitals reported policies that require site-marking.
  2. Forty five percent of respondents who operate at children’s hospitals reported policies allowing providers including residents, nurse practitioners or physician’s assistants to perform site marking.
  3. The Attending physician must be present at the initial time-out for 84.3% of respondents operating at children’s hospitals, and must lead the time out for 30.6%.
  4. The majority (84.4%) of respondents operating at children’s hospitals were satisfied with their hospital’s site marking policy, and (87.1%) with their hospital’s surgical checklist policy for pediatric otolaryngology procedures.
  5. Twenty one percent of survey respondents report involvement in a wrong site surgery at some point in their career.

Overall, there was NOT a significant difference of opinion regarding these issues between the different surgical settings surveyed.

The results of this survey serve as a starting point from which future studies may define protocols that enhance patient safety and quality practice. While this data provides food for thought, they should not be used as indicators of either “best practice” or “standard of care.” Over the next two years, the committee will participate in developing outcome surveys for some of the more common pediatric otolaryngology surgeries and work to get the survey into the surgical consumer assessment of healthcare providers and systems (S-CAHPS) database.



No site marking required
(time out alone
covers the procedure)


The patient is marked in a way that designates the surgery


Both ears
must be marked

Ear tube insertion

88/133 (66.2%)

29/133 (21.8%)

16/133 (12.0%)

Adenotonsillar surgery

131/135 (97.0%)

4/135   (3.0%)


Airway endoscopy procedures

129/134 (96.3%)

5/134   (3.7%)


Nasal procedures

90/128 (70.3%)

38/128 (29.7%)


Obvious surgical sites (neck abscess drainage)

31/134 (23.1%)

103/134 (76.9%)