Quick question: can you name the three phases of the WHO Surgical Safety Checklist and which step you feel most improves immediate postop pain control and overall safety? I like confirming our multimodal analgesia and antiemetic plan during Time Out, which keeps PACU pain scores consistently low on our day surgery list.
Sign In, Time Out, and Sign Out. I get the biggest bump by locking in multimodal and any block at Sign In — confirm IV acetaminophen/NSAID timing and have ultrasound/local in the room so the block’s done pre-incision. “which keeps PACU pain scores consistently low on our day surgery list.” — same for us, but if we wait until Time Out we sometimes miss the pre-incision window; do you pre-chart those meds to auto-fire?
Sign In, the team pause, and Sign Out. For fast day-surgery lists like yours, the biggest win for me is dexamethasone early and a firm PACU rescue plan at Sign Out — block check plus ketamine 0.1–[redacted]/kg PRN keeps opioids minimal and scores low. @zlambert03 do you hard-stop to ensure NSAID is on board before tourniquet release?
Before anesthesia, pause before cut, and before leaving the room. Biggest safety and pain bump for me is that last one: explicit check that local infiltration is done before dressings and that ketorolac or IV acetaminophen timing hits right as they roll into PACU — your “consistently low” scores track with that. Agree with @zlambert03 on early dex, but if turnover is tight I’d prioritize the exit check over adding a block; do you chart a target pain score there?
Quick example: I set a timer at induction so IV acetaminophen lands 15–20 minutes before emergence; that steadies “PACU pain scores” on fast-turnover lists. In the final check I make a hard stop to confirm local infiltration volume is documented and a PACU rescue plan is in place, but I hold ketorolac if renal function or bleeding risk isn’t ideal.