Related Experiment Video
Updated: Dec 8, 2025
Application of Hemostatic Devices in Laparoscopic Hepatectomy
Published on: April 19, 2022
Hemostasis Checklist Reduces Bleeding and Blood Product Consumption After Cardiac Surgery
Jason M Ali1, Caroline Gerrard1, James Clayton1
1Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom.
Insights
A new hemostasis checklist significantly reduced mediastinal bleeding and reexploration after cardiac surgery. This intervention also lowered blood product use and healthcare costs, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Patient Safety
- Surgical Hemostasis
Background:
- Mediastinal bleeding is a significant complication following cardiac surgery.
- Reexploration and blood product transfusion are linked to poorer patient outcomes, increased morbidity, and mortality.
- Developing strategies to mitigate mediastinal bleeding is crucial for improving surgical results.
Purpose of the Study:
- To develop and implement a hemostasis checklist to reduce mediastinal bleeding after cardiac surgery.
- To assess the impact of the checklist on reexploration rates and blood product consumption.
- To evaluate the associated changes in patient length of stay and financial costs.
Main Methods:
- A multidisciplinary team developed a hemostasis checklist.
- The checklist includes surgical sites and coagulation factors, performed before sternal wire closure.
- A comparative analysis was conducted on patient outcomes before and after checklist implementation.
Main Results:
- A significant reduction in reexploration rates (3.5% to 1.9%) and major bleeding (6.1% to 2.8%) was observed post-implementation.
- Blood product consumption decreased substantially, resulting in savings of $430,513.
- Checklist use led to reduced intensive care unit and hospital length of stay, with progressive improvement over two years.
Conclusions:
- A simple hemostasis checklist effectively reduces mediastinal bleeding and reexploration rates in cardiac surgery.
- The checklist implementation led to decreased blood product usage, shorter hospital stays, and significant cost savings.
- Perioperative bleeding is a preventable complication, and checklists are valuable tools for enhancing surgical safety and efficiency.
Background:
Considerable mediastinal bleeding is a recognized complication after cardiac surgery and may require reexploration and blood product transfusion, both of which are associated with inferior clinical outcomes with greater morbidity and mortality. The aim of this study was to develop a hemostasis checklist, with the intention of reducing mediastinal bleeding after cardiac surgery.
Methods:
A hemostasis checklist was developed with multidisciplinary collaboration. It contains 2 components: a series of surgical sites and factors affecting coagulation status. The checklist is performed at a time-out before sternal wire insertion. Analysis compared outcomes for patients undergoing cardiac surgery in the 1 year before and 2 years after implementation.
Results:
A total of 5542 patients underwent surgery during the study. After we implemented the checklist, there was a significant reduction in the reexploration rate (3.5% versus 1.9%; P < .001) and the proportion of patients bleeding greater than 1 L in 12 hours (6.1% versus 2.8%; P < .001). There was a major reduction in consumption of blood products, saving $430,513. There was progressive improvement in the second year after implementation. Checklist implementation was also associated with reduced intensive care unit and hospital length of stay, adding to the financial benefit.
Conclusions:
Implementation of a simple and quickly performed hemostasis checklist has had a sustained impact over the 2 years after implementation, reducing the incidence of noteworthy mediastinal bleeding and reexploration, which has resulted in a major reduction in blood product consumption. Together, these have resulted in an associated reduction in intensive care unit and hospital length of stay, and a considerable financial savings. This highlights that perioperative bleeding is a preventable complication.
Related Concept Videos
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:30Venous Thrombosis IV: Nursing Management
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management