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Adherence to the cardiac surgery checklist decreased mortality at a teaching hospital: A retrospective cohort study
Omar Asdrúbal Vilca Mejia1, Frederico Carlos Cordeiro de Mendonça2, Lucimar Aparecida Barrense Nogueira Sampaio3
1Quality and Safety Surgical Unit, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Insights
Implementing the cardiac surgical safety checklist significantly reduced patient mortality. Higher adherence and completeness of the checklist correlated with lower surgical death rates, improving patient safety.
Area of Science:
- Cardiovascular Surgery
- Patient Safety
- Quality Improvement
Background:
- Cardiac surgical mortality remains a significant concern in healthcare.
- Effective implementation of safety protocols is crucial for improving patient outcomes.
- The InCor-Checklist "Five steps to safe cardiac surgery" was introduced to enhance safety in cardiac procedures.
Purpose of the Study:
- To evaluate the impact of adherence to a cardiac surgical checklist on patient mortality.
- To assess the correlation between checklist completeness and surgical mortality rates.
Main Methods:
- Retrospective cohort study analyzing 8139 patients undergoing cardiac surgery from 2013-2019.
- Assessed adherence and completeness of the InCor-Checklist post-2015 implementation.
- Used EuroSCORE II for expected mortality risk and Pearson's coefficient for correlation analysis.
Main Results:
- Surgical mortality decreased from 8.22% to 3.13% following checklist implementation.
- Increased checklist use (58% to 100%) correlated with reduced mortality (r=88.9%).
- Higher checklist completeness showed a strong inverse relationship with mortality (r=94.1%).
Conclusions:
- Implementation and adherence to the InCor-Checklist are associated with decreased mortality in cardiac surgery.
- The checklist contributes to forming a stronger patient safety culture.
- Adherence to standardized safety protocols is vital for reducing surgical risks.
Objective:
To evaluate the impact of adherence to the cardiac surgical checklist on mortality at the teaching hospital.
Methods:
A retrospective cohort study after the implementation of the cardiac surgical safety checklist in a reference hospital in Latin America. All patients undergoing coronary artery bypass surgery and/or heart valve surgery from 2013 to 2019 were analyzed. After the implementation of the project InCor-Checklist "Five steps to safe cardiac surgery" in 2015, the correlation between adherence and completeness of this instrument with surgical mortality was assessed. The EuroSCORE II was used as a reference to assess the risk of expected mortality for patients. Cross-sectional questionnaires were during the implementation of the InCor-Checklist. To perform the correlation, Pearson's coefficient was calculated using R software.
Results:
Since 2013, data from 8139 patients have been analyzed. The average annual mortality was 5.98%. In 2015, the instrument was used in only 58% of patients; in contrast, it was used in 100% of patients in 2019. There was a decrease in surgical mortality from 8.22% to 3.13% for the same group of procedures. The results indicate that the greater the checklist use, the lower the surgical mortality (r = 88.9%). In addition, the greater the InCor-Checklist completeness, the lower the surgical mortality (r = 94.1%).
Conclusion:
In the formation of the surgical patient safety culture, the implementation and adherence to the InCor-Checklist "Five steps to safe cardiac surgery" was associated with decreased mortality after cardiac surgery.
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