Cardiothoracic surgical education and training
Process improvement in cardiac surgery: Development and implementation of a reoperation for bleeding checklist

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Objective

High-performing health care organizations differentiate themselves by focusing on continuous process improvement initiatives aimed at enhancing patient outcomes. Reoperation for bleeding is an event associated with considerable morbidity risk. Hence, our primary objective was to develop and implement a formal operative checklist to reduce technical reasons for postoperative bleeding.

Methods

From January 1, 2011, through June 30, 2012, 5812 cardiac surgical procedures were performed at Cleveland Clinic (Cleveland, OH). A multidisciplinary team developed a simple, easy-to-perform hemostasis checklist based on the most common sites of bleeding. An extensive educational in-service was performed before limited, then universal, checklist implementation. Geometric charts were used to track the number of cases between consecutive reoperations for bleeding. We compared these before (phase 0) and after the first limited implementation phase (phase 1) and the universal implementation phase (phase 2) of the checklist.

Results

The average number of cases between consecutive reoperations for bleeding increased from 32 in phase 0 to 53 in both phase 1 (P = .002) and phase 2 (P = .01).

Conclusions

A substantial reduction in reoperation for bleeding cases followed implementation of a formalized hemostasis checklist. Our findings underscore the important influence of memory aids that focus attention on surgical techniques to improve patient outcomes in a complex, operative work environment.

CTSNet classification

2
18

Abbreviations and Acronyms

CABG
coronary artery bypass grafting
WHO
World Health Organization

Cited by (0)

This study was supported, in part, by the Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery, held by Dr Sabik; and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research, held by Dr Blackstone. These individuals played no role in the collection of data or analysis and interpretation of the data, and had no right to approve or disapprove publication of the finished manuscript.

Disclosures: Authors have nothing to report with regard to commercial support.