Watch out! Where’s the time gone?

We note that the government’s latest initiative in improving infection control in hospitals now involves a ‘bare below the elbow’ uniform policy [1]. A concern we have with respect to removing a wrist-watch from the anaesthetist’s arm is the potential loss of the ability to record, accurately, peri-operative observations during a patient’s journey through the operating suite. According to the Association of Great Britain and Ireland recommendations, anaesthetists are required to record core data at intervals no longer than every 5 min, and more frequently if the patient is clinically unstable [2]. Despite the potential for synchronising clocks within the theatre suite using radio-frequency wall clocks, they are not infallible, and many hospitals still rely on simple wall clocks and the time display on anaesthetic monitors [3, 4]. Recently we performed a survey of all clocks within our theatre suites, comparing the displayed time against an analogue wrist-watch which had been accurately set to Greenwich Mean Time (GMT). Of the 58 clocks examined, only 12 had a discrepancy of <30 s either side of GMT. In total 22 of the clocks were found to be fast (mean 8 min 24 s; range 3 s to 58 min 56 s) and 35 were slow (mean 2 min 40 s; range 4 s to 17 min 21 s). More importantly, the average discrepancy between clocks encountered during a single patient pathway through theatres was over 19 min (range 1 min 51 s to 58 min 56 s). Excluding the anaesthetist’s wrist-watch removes the only continuous time-piece which follows the patient’s journey through the theatre suite. This introduces potential inaccuracies in time-keeping which may well have implications both on the recorded length of theatre cases as well as accurate documentation of critical events.