Effective January 26, 2026: Standard 8-G-1 becomes applicable to OBS, OBP, ASC, OMS, I-SURG surgical/procedural cases, including those performed under QUAD A’s Class A Anesthesia definition (local, topical anesthesia or minimal sedation).
QUAD A standard 8-G-1: A “Time Out” protocol is in place, practiced, and documented in the clinical record prior to every operation.
This protocol must include:
A pre-operative verification process including clinical records, imaging studies, surgical fire risk, and any implants identified, and be reviewed by the operating room team.
Missing information or discrepancies must be addressed in the clinical record at this time.
Marking the operative site: Surgical procedures calling for right/left distinction; multiple structures (breasts, eyes, fingers, toes, etc.) must be marked while the patient is awake and aware, if possible. The person performing the surgery should do the site marking. The site must be marked so that the mark will be visible after the patient has been prepped and draped. A procedure must be in place for patients who refuse site marking.
Immediately before starting the surgical procedure, conduct a final verification by at least two (2) members of the surgical team confirming the correct patient, surgery, site marking(s), and, as applicable, implants and special equipment or requirements. As a “fail-safe” measure, the surgical procedure is not started until any and all questions or concerns are resolved.
Procedures performed in non–operating room settings must include site marking for any procedures involving laterality or multiple structures.
Why the Time-Out Protocol Matters—Even for Local/Topical Anesthesia/Minimal Sedation Cases
When we think about patient safety checklists, the surgical time-out is often associated with major procedures under general anesthesia. But evidence and experience consistently show that time-out protocols are just as critical for cases performed under local/topical anesthesia or minimal sedation—especially in busy outpatient and office-based settings, such as facilities performing ophthalmic procedures.
Procedures performed under local anesthesia are often perceived as routine, quick, and low risk. This perception can unintentionally lead to shortcuts. However, wrong-site procedures, patient misidentification, incorrection implants, and medication errors occur more frequently in minor procedures precisely because teams feel familiar and rushed due to the nature of these cases. A formal time-out creates a vital pause that counters complacency.
Even in simple cases, the time-out helps prevent:
Wrong patient or wrong site procedures
Wrong procedure or implant
Incorrect side, tooth, digit, eye, or lesion
Medication or dosage errors
Allergy concerns (i.e., Latex allergy, medications)
Pertinent medical concerns (i.e., diabetic, bleeding disorders)
Miscommunication among team members
Documentation discrepancies
Missing equipment or supplies needed to perform the case
The procedure does not begin until all questions are resolved
These errors can have lasting physical, legal, and reputational consequences—regardless of anesthesia type.
In local/topical anesthesia or minimal sedation cases, patients are awake and aware. Conducting the time-out in their presence:
Patients consistently report greater confidence in care when they see safety checks performed deliberately.
Consistency Builds a Safety Culture
Safety protocols are most effective when they are universal and standardized, not conditional. Performing a time-out for every procedure—large or small—sends a clear message:
Patient safety is not negotiable, and no case is “too minor” for verification.
Consistency also reduces confusion among staff and trainees by eliminating judgment calls about when a time-out is “necessary.”
Accrediting Organizations and regulatory bodies, including QUAD A, expect “time-out” protocols to be followed for all invasive procedures, including those under local anesthesia. Skipping the process can expose providers and institutions to compliance gaps and legal risk if an adverse event occurs.
A proper time-out takes less than a minute, but it can prevent errors that last a lifetime. By honoring the protocol in every case—including those under local anesthesia—we reinforce our commitment to safe, reliable, and patient-centered care. Because patient safety should never depend on the complexity of the procedure.
Thank you for your continued dedication to safety and excellence.
Should you have any questions, please email them to standards@quada.org.
Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.