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Clinical Articles, Lead Article

New checklist makes the cardiac cath lab safer for patients

Since 2010 it has been mandatory for all UK theatre teams to use safety checklists before operating, yet despite this there are no standardised systems currently in place in cardiac catheterisation laboratories (CCLs).

In 2013, a Shine-funded project at Royal Brompton and Harefield NHS Foundation Trust set out to develop a safety checklist for the CCL. This was derived from the World Health Organisation (WHO) safe surgery checklist but specifically modified for use in the CCL.

Dr Elizabeth Haxby, Lead Clinician in Clinical Risk at Royal Brompton Hospital, explains:

“The WHO safe surgery checklist has been shown to reduce morbidity and mortality during surgical procedures. We wanted to develop a similar style checklist specifically for the CCL and see what impact it could have on safety, efficiency, staff experience and department costs, whilst also for the first time examining its effect on patient experience.”

Dr Elizabeth Haxby (Royal Brompton Hospital)

Dr Elizabeth Haxby (Royal Brompton Hospital)

Following a three month development process using Plan, Do, Study, Act (PDSA) cycles to gather staff feedback, the team arrived at a simple, standardised checklist that could be applied to the range of different procedures taking place in the CCL. This was introduced at Royal Brompton Hospital, a specialist referral centre for treatment of complex adult and paediatric heart and lung disease.

The checklist procedure has four parts:

  • Team brief: given by the operator to the team before the start of the list, followed by the three part checklist.
  • Sign in: pre-procedure checks carried out by a nurse prior to the patient being put on the table.
  • Time out: a briefing delivered by the operator immediately prior to the start of the case.
  • Sign out: a debrief from the operator, post-procedure checks and confirmation of case details for ward handover.

In addition to introduction of the checklist, the concept of a Team Brief  was also introduced to ensure that all team members understood the plan for the list, any potential problems were identified and plans put in place to mitigate these prior to commencing the first intervention.

Quality improvement methodology using PDSA cycles was employed to design a safe procedure checklist which was relevant and easy to use by staff. This also involved   establishing how use could be measured, recorded and reported. A number of  markers were measured in addition to checklist compliance including safety, efficiency, and outcome data together with patient and staff satisfaction.

At one year, the checklist was being used in >95% of procedures, and was associated with a reduction in screening times. Patient

and staff questionnaires showed high degrees of satisfaction with procedural safety, with nursing staff in particular reporting a greater level of team working during procedures. Use of the checklist continues to be monitored, with feedback to care groups and individual operators. Longer term safety outcomes, in particular mortality and morbidity, will be analysed.

Speaking to BJC Arrhythmia Watch, Dr Haxby said: “Patient safety is the top priority for the NHS and we have an obligation to explore all means through which patient outcome and experience can be improved. Safe procedure checklists are a simple way to reduce risk and make it easier for healthcare staff to work together more effectively as teams to prevent common problems in high risk environments such as the CCL.”

She added: “Procedures are increasingly complex, requiring advanced technology, delivered by larger teams in patients with significant co-morbidities, and satisfactory outcomes depend on the careful coordination of people, processes and equipment. Checklists can make it easier to ‘do the right thing’ but their introduction needs thoughtful engagement from all healthcare professionals to facilitate ownership and integration into day to day care. Our experience at the Royal Brompton has shown that this process requires a dedicated team which has persistence, provides regular updates and reports with rapid response to feedback from staff and acquisition of patient  experience information.”

Published on: August 5, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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