Use of an intraoperative checklist to decrease the incidence of re-exploration for postoperative bleeding after cardiac surgery

Boxtel, Astrid G.M. van; Veghel, Dennis van; Hamad, Mohamed A. Soliman; Schulz, Daniela N; Stepaniak, Pieter S.; Straten, Albert H.M. van

doi:10.1093/icvts/ivx130

Cited by 29 publications

(19 citation statements)

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“…[12][13][14] Logically, this outcome suggests that a checklist to improve flow of information and completeness of requisite clinical care protocols before a patient reaches the operating room can reduce unwanted variation in preparation and planning and improve care. 29 Our findings suggest that effective application of the preoperative SURPASS may achieve this. The reduction in emergency reoperations when preoperative SUR-PASS had been used replicates studies showing a decrease in reoperations after implementing intraoperative surgical checklists.…”

Section: Discussionmentioning

confidence: 62%

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization’s Checklists in Surgery

et al. 2020

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IMPORTANCE Checklists have been shown to improve patient outcomes in surgery. The intraoperatively used World Health Organization surgical safety checklist (WHO SSC) is now mandatory in many countries. The only evidenced checklist to address preoperative and postoperative care is the Surgical Patient Safety System (SURPASS), which has been found to be effective in improving patient outcomes. To date, the WHO SSC and SURPASS have not been studied jointly within the perioperative pathway. OBJECTIVE To investigate the association of combined use of the preoperative and postoperative SURPASS and the WHO SSC in perioperative care with morbidity, mortality, and length of hospital stay. DESIGN, SETTING, AND PARTICIPANTS In a stepped-wedge cluster nonrandomized clinical trial, the preoperative and postoperative SURPASS checklists were implemented in 3 surgical departments (neurosurgery, orthopedics, and gynecology) in a Norwegian tertiary hospital, serving as their own controls. Three surgical units offered additional parallel controls. Data were collected from November 1, 2012, to March 31, 2015, including surgical procedures without any restrictions to patient age. Data were analyzed from September 25, 2018, to March 29, 2019. INTERVENTIONS Individualized preoperative and postoperative SURPASS checklists were added to the intraoperative WHO SSC. MAIN OUTCOMES AND MEASURES Primary outcomes were in-hospital complications, emergency reoperations, unplanned 30-day readmissions, and 30-day mortality. The secondary outcome was length of hospital stay (LOS). RESULTS In total, 9009 procedures (5601 women [62.2%]; mean [SD] patient age, 51.7 [22.2] years) were included, with 5117 intervention procedures (mean [SD] patient age, 51.8 [22.4] years; 2913 women [56.9%]) compared with 3892 controls (mean [SD] patient age, 51.5 [21.8] years; 2688 women [69.1%]). Parallel control units included 9678 procedures (mean [SD] patient age, 57.4 [22.2] years; 4124 women [42.6%]). In addition to the WHO SSC, adjusted analyses showed that adherence to the preoperative SURPASS checklists was associated with reduced complications (odds ratio [OR], 0.70; 95% CI, 0.50-0.98; P = .04) and reoperations (OR, 0.42; 95% CI, 0.23-0.76; P = .004). Adherence to the postoperative SURPASS checklists was associated with decreased readmissions (OR, 0.32; 95% CI, 0.16-0.64; P = .001). No changes were observed in mortality or LOS. In parallel control units, complications increased (OR, 1.09; 95% CI, 1.01-1.17; P = .04), whereas reoperations, readmissions, and mortality remained unchanged. CONCLUSIONS AND RELEVANCE In this nonrandomized clinical trial, adding preoperative and postoperative SURPASS to the WHO SSC was associated with a reduction in the rate of complications, reoperations, and readmissions.

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Section: Discussionmentioning

confidence: 62%

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization’s Checklists in Surgery

et al. 2020

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“…In addition to the collaboration project, there have been quality improvement projects in both SJG Weert and the Catharina cardiac centre that might have influenced the results of this study. For instance, in Catharina cardiac centre, improvement projects have been implemented within the cardiothoracic surgery department with positive effects on outcomes [24].…”

Section: Discussionmentioning

confidence: 99%

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital

Veghel

Hamad

Schulz

et al. 2020

BMC Health Serv Res

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Background: Value-based healthcare (VBHC) is a promising strategy to increase patient value. For a successful implementation of VBHC, intensive collaborations between organizations and integrated care delivery systems are key conditions. Our aim was to evaluate the effects of a pilot study regarding enhancing regional integration between a cardiac centre and a referring hospital on patient-relevant clinical outcomes and patient satisfaction. Methods:The study population consisted of a sample of patients treated for coronary artery disease by use of a coronary artery bypass graft (CABG) or a percutaneous coronary intervention between 2011 and 2016. Since 2013, the two hospitals have implemented different interventions to improve clinical outcomes and the degree of patient satisfaction, e.g. improvement of communication, increased consultant capacity, introduction of outpatient clinic for complex patients, and improved guideline adherence. To identify intervention effects, logistic regression analyses were conducted. Patients' initial conditions, like demographics and health status, were included in the model as predictors. Clinical data extracted from the electronic health records and the hospitals' cardiac databases as well as survey-based data were used. Results: Our findings indicate a non-significant increase of event-free survival of patients treated for coronary artery disease between 2014 and 2016 compared to patients treated between 2011 and 2013 (97.4% vs. 96.7% respectively). This non-significant improvement over time has led to significant better outcomes for patients referred from the study referring hospital compared to patients referred from other hospitals. The level of patient satisfaction (response rate 32.2%; 216 out of 669) was improved and reached statistically significant higher scores regarding patient information and education (p = .013), quality of care (p = .007), hospital admission and stay (p = .032), personal contact with the physician (p = .024), and total impression (p = .007).

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“…In addition to the collaboration project, there have been quality improvement projects in both SJG Weert and the Catharina cardiac centre that might have in uenced the results of this study. For instance, in Catharina cardiac centre, improvement projects have been implemented within the cardiothoracic surgery department with positive effects on outcomes [24].…”

Section: Discussionmentioning

confidence: 99%

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital

Veghel

Hamad

Schulz

et al. 2020

Preprint

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Background Value-based healthcare (VBHC) is a promising strategy to increase patient value. For a successful implementation of VBHC, intensive collaborations between organizations and integrated care delivery systems are key conditions. Our aim was to evaluate the effects of a pilot study regarding enhancing regional integration between a cardiac centre and a referring hospital on patient-relevant clinical outcomes and patient satisfaction.Methods The study population consisted of a sample of patients treated for coronary artery disease by use of a coronary artery bypass graft or a percutaneous coronary intervention between 2011 and 2016. Since 2013, the two hospitals have implemented different interventions to improve clinical outcomes and the degree of patient satisfaction, e.g. improvement of communication, increased consultant capacity, and introduction of outpatient clinic for complex patients. To identify intervention effects, logistic regression analyses were conducted. Patients’ initial conditions, like demographics and health status, were included in the model as predictors. Clinical data extracted from the electronic health records and the hospitals’ cardiac databases as well as survey-based data were used.Results Our findings indicate a non-significant increase of event-free survival of patients treated between 2014 and 2016 compared to patients treated between 2011 and 2013 (97.4% vs. 96.7% respectively). This non-significant improvement over time has led to significant better outcomes for patients referred from the study referring hospital compared to patients referred from other hospitals. The level of patient satisfaction (response rate 32.2%;216 out of 669) was improved and reached statistically significant higher scores regarding patient information and education (p=.013), quality of care (p=.007), hospital admission and stay (p=.032), personal contact with the physician (p=.024), and total impression (p=.007).Conclusions This study shows a promising effect of regional integration. An intensified collaboration in the care chain, organized in a structured manner between a cardiac centre and a referring hospital and aiming at high quality, resulted in successful improvement of clinical outcomes and degree of patient satisfaction. The applied method may be used as a starting point of regional integration with other referring hospitals. We encourage others to organize the whole care chain to continuously improve patient-relevant outcomes and patient satisfaction.Trial registration: ISRCTN11311830. Registered 01 October 2018 (retrospectively registered)

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Use of an intraoperative checklist to decrease the incidence of re-exploration for postoperative bleeding after cardiac surgery

Abstract: 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.

Cited by 29 publications

References 13 publications

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization’s Checklists in Surgery

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization’s Checklists in Surgery

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital

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