How to Run a Pre-Amputation Time-Out: A Step-by-Step TOBA Checklist
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A practical walkthrough for adding a Time-Out Before Amputation to your clinic or hospital workflow, from vascular check to patient consent.
A Time-Out Before Amputation (TOBA) works best when it is a short, repeatable routine rather than a one-off conversation. This guide walks through how a team can set one up, using the four TOBA questions from Desmond Bell's SAWC talk as the backbone.
Step 1: Decide who owns the pause
Name one person, such as the surgeon, the wound care lead, or a nurse coordinator, who is responsible for calling the time-out. Without a named owner, the pause tends to get skipped when schedules are tight.
Step 2: Confirm vascular status
Check that arterial flow has been objectively assessed. Absent pulses can point to no flow, but palpable pulses do not prove adequate flow. Look for noninvasive vascular test results in the chart, not only a pulse note.
Step 3: Ask whether revascularization was considered
If vascular testing shows impaired flow, confirm that a vascular specialist has weighed in and that the decision is recorded.
Step 4: Confirm multidisciplinary input
Verify that podiatry, vascular, infectious disease, endocrinology, or other relevant teams were consulted as appropriate.
Step 5: Verify the patient is fully informed
The patient should understand the alternatives, the risks, and what limb preservation options exist. Document that conversation.
Step 6: Record the time-out
Capture the outcome in the chart so it is auditable. Consistent wound care documentation makes each of these items easy to find, and our guide to what to capture at every DFU visit shows which fields matter most.
Getting a policy adopted
- Start with a one-page checklist.
- Pilot it in one service line.
- Review a sample of cases monthly.
- Bring results to leadership as a proposed hospital policy.
For background on why this matters, see Early DFU Care and Time-Out Before Amputation.