| Q1. | Evaluate 9 items changed by timeout with implementation of surgical checklist (by self-assessment) | |||||
| (5 points: Excellent, 4 points: Good, 3 points: Average, 2 points: Fair, 1 point: Poor) | ||||||
| 5: Excellent | 4: Good | 3: Average | 2: Fair | 1: Poor | ||
| 1) Self-introduction of members | □ | □ | □ | □ | □ | |
| 2) Patient referral | □ | □ | □ | □ | □ | |
| 3) Surgical procedure | □ | □ | □ | □ | □ | |
| 4) Scheduled operating time | □ | □ | □ | □ | □ | |
| 5) Predicted blood loss | □ | □ | □ | □ | □ | |
| 6) Important matters in operation | □ | □ | □ | □ | □ | |
| 7) Timing of antibiotics | □ | □ | □ | □ | □ | |
| 8) Important matters in anesthesia | □ | □ | □ | □ | □ | |
| 9) Preparation of required materials and equipment | □ | □ | □ | □ | □ | |
| Q2. | What are your changes in recognition by implementation of timeout? (multiple answers allowed) | |||||
| 1) Increased sense of responsibility | □ | |||||
| 2) Patient-centered operating team | □ | |||||
| 3) Increased communication | □ | |||||
| 4) Bright atmosphere | □ | |||||
| 5) Getting interested in multidisciplinary | □ | |||||
| 6) Reduction of mental stresses | □ | |||||
| 7). Reduction of physical stresses | □ | |||||
| 8) Growing tension | □ | |||||
| Q3. | Free comment. | |||||