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Use of an intraoperative checklist to decrease the incidence of re-exploration for postoperative bleeding after
Astrid G M van Boxtel1, Dennis van Veghel2, Mohamed A Soliman Hamad1
1Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands.
Insights
Implementing an intraoperative checklist significantly reduced re-exploration for bleeding after cardiac surgery. This simple tool proved effective in improving patient outcomes and surgical safety.
Area of Science:
- Cardiovascular Surgery
- Patient Safety
- Quality Improvement
Background:
- Postoperative bleeding requiring re-exploration is a significant complication after cardiac surgery.
- Reducing the incidence of re-exploration for bleeding is a key goal in cardiac surgical care.
Purpose of the Study:
- To evaluate the impact of an intraoperative checklist on the rate of re-exploration for bleeding following cardiac surgery.
- To assess the feasibility and effectiveness of implementing a standardized checklist in a cardiac surgical setting.
Main Methods:
- An intraoperative checklist was implemented across all cardiac surgical procedures.
- Data on re-exploration for bleeding were collected and analyzed before and after checklist implementation.
- A comparative analysis was performed between historical and recent patient cohorts.
Main Results:
- The incidence of re-exploration for bleeding decreased from 3.5% (112/3210) before implementation to 1.8% (29/1607) after implementation (P < 0.05).
- The checklist was successfully integrated into the workflow of the Catharina Heart Center.
- Data collection and validation were performed according to established quality standards.
Conclusions:
- An intraoperative checklist is a feasible, low-cost, and effective tool for reducing re-exploration for bleeding after cardiac surgery.
- The implementation of this checklist demonstrates the positive impact of transparency and standardized protocols in improving surgical outcomes.
- This study highlights a successful quality improvement initiative in cardiac surgery.
Objectives:
We have implemented an intraoperative checklist aiming to reduce the incidence of re-exploration for bleeding after cardiac surgery. The present report addresses the results of adopting such a checklist regarding the incidence of postoperative bleeding.
Methods:
The checklist was implemented by presenting it in several staff meetings of the Catharina Heart Center. Copies of the checklist were presented in every operating room. Data were collected by the Catharina Heart Center, aligned with the 'Meetbaar Beter' data manual and validated by 'Meetbaar Beter' through their data quality system. The incidence of re-exploration for bleeding was analysed in a variable life-adjusted display curve. The patient population operated after the implementation of the checklist was compared with a recent historical population before its implementation.
Results:
From January 2013 through April 2016, 4817 cardiac surgical procedures were performed in our institution. Before May 2015, 3210 procedures were performed (Group 1), complicated by 112 re-exploration for bleeding (3.5%). The 'reoperation for bleeding checklist' was implemented on 1 May 2015. After this date, the number of re-explorations for bleeding decreased to 29 (1.8%) of the 1607 cardiac surgical procedures (Group 2) (P < 0.05).
Conclusions:
An intraoperative checklist is feasible to implement, low cost, quick and simple to measure with a significant reduction in the incidence of re-exploration for bleeding. This report shows an example of the positive effects of transparency in publishing outcomes' data in cardiac surgery.
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