Use of a safe procedure checklist in the cardiac catheterisation laboratory

Abstract

BackgroundThe use of the WHO safe surgery checklist has been shown to reduce morbidity and mortality from surgical procedures. However, whether a WHO-style safe procedure checklist can improve safety in the cardiac catheterisation laboratory (CCL) has not previously been investigated.ObjectivesThe authors sought to design and implement a safe procedure checklist suitable for all CCL procedures, and to assess its impact over the course of 1 year.MethodsIn the first 3 months, weekly PDSA cycles (Plan-Do-Study-Act) were used to optimise the design of the checklist through testing and staff feedback, and team briefing sessions were introduced before each procedure list. The impact of the checklist and team briefs was assessed by analysing in-house procedural data subsequently submitted to national audit databases. Staff and patient questionnaires were performed throughout the year.ResultsIntroduction of the checklist was associated with a significant reduction of 3 min in average turnaround time (95% CI 25 s to 6 min, p=0.027). Similarly, an initial reduction in patient radiation exposure was recorded (dose area product reduction of 641.5 cGy/cm2; 95% CI 255.9 to 1027.1, p=0.002). The rate of reported complications from all procedures fell significantly from 2.0% in 2012/2013 (95% CI 1.6% to 2.4%) to 0.8% in 2013/2014 (95% CI 0.6% to 1.1%, p≤0.001). Staff climate questionnaires showed that technicians and radiographers gave more positive responses at the end of the study period compared with the beginning (p=0.001).ConclusionsThe use of a team brief and WHO-derived safe procedure checklist in the CCL was associated with decreased radiation exposure, fewer procedural complications, faster turnarounds and improved staff experience.

Kreislaufstillstand unter besonderen Umständen

“…Die Verwendung von Sicherheitschecklisten zur Vermeidung von menschlichen Fehlern sollen gefördert werden [ 439 , 441 , 442 ]. Dies dient der Reduktion von Komplikationen, einer verbesserten Teamkommunikation – und Performance [ 443 ].…”

The design and evaluation of a pre-procedure checklist specific to the cardiac catheterisation laboratory

“…6,7 According to the Australian Commission on Safety and Quality in Health Care, the cost associated with hospital-acquired adverse events in the Australian public healthcare system was estimated to be $4.1 billion in the 2017e2018 financial year. 8 Similar to most procedural areas and operating theatres, patients in the CCL are at risk of adverse events, 9,10 for example, incorrect patient and procedure matching often results from poor teamwork and communication. 11 Therefore, processes for identifying patients for the correct cardiac intervention or procedure are essential to ensure that the right patient receives the right care.…”

Why industrial methods do not work in healthcare: an analytical approach

“…2,3 In healthcare, lean is expected to result in decreased costs, enhanced safety and improved quality of care. [6][7][8][9] Healthcare systems are under pressure to improve patient outcomes using evidence-based interventions. Initially, lessons from aviation were suggested to reduce errors in surgery.…”

“…5 Some of these applications such as the use of checklists, time-out procedures and patient handovers showed to reduce complications in the operating room and similar settings. [6][7][8][9] Healthcare systems are under pressure to improve patient outcomes using evidence-based interventions. Although lean management approaches have been widely applied, evidence-based information about its effectiveness in healthcare is still lacking.…”