1. Adapted WHO Safe Surgical Checklist in Interventional Cardiology
National Safety Standards for Invasive Procedures (NatSSIP’s) 2, 4
Place: Cardiac Catheter Laboratory (CCL)– Non-NHS service Author: I V George ; A Oliveira
Abstract
Objective: To ensure the effective integration of adapted WHO checklist, enable and embed the safety culture, to achieve regular and consistent briefing and de-briefing for all patients undergoing interventional procedure in CCL. Methods: Data was collected from total of 75 patients within 3 cohorts and 10 staffs using simple data collection tool and snapshot perception study. Results: Progressive improvement in all aspects from cohort 1 to cohort 3, 100% completion of the checklist at cohort 3, lowest average effective process time (3.6 minutes), considerable reduction in delay from start time of the procedure and 90% increase in perception level among staffs. Conclusion: Effective use of resources, quality and safety will be positively enhance by good MDT work, communication with a structured process .
Method
Prospective study in total of 75 patients over 4 months undergoing procedures in CCL was audited for the completeness of the WHO checklist, duration of briefing and de-briefing process times, delay in the start of procedure and snap shot perception of team view on effectiveness and safety.
Study was performed by cohorts; 1st cohort of 15 consecutive patients before the introduction of adapted checklist, I week after introduction 2nd cohort of 45 consecutive patients and 3 months later re-audited with 3rd cohort of15 consecutive patients Team view was collected using snapshot perception study after 1st, 2nd and 3rd cohorts.
Results
Actual Start Time
Introduction
In 2008, World Health Organisation (WHO) launched surgical safety checklist as part of the initiative “Safe Surgery Saves Lives” aimed to improve the quality and safety of surgery by reducing complications and death by team work 1,2,4,5.
In 2009, NHS adapted the checklist with the core content in collaboration with National Reporting and Learning Services (NRLS) expert group for all surgical procedures to reduce the harm as a direct result of the surgery 2,3,4,5.
In 2015, NHS England produced NatSSIP’s guidance 2,4,5. 14 % of overall safety incident reported from 1993 to 2003 was from cardiovascular along with ENT2,4, however as a proactive member in 2010, CCL adapted the WHO checklist as local SSIP to effectively integrate for use within the interventional cardiology.
Completion Of WHO Checklist
Average Time for Briefing and De-briefing Process
Staff Perception of Safety and Effectiveness
Discussion
Cohort 1 has the worst statistical data overall, no structure, communication between the MDT, prolonged delays, however informal briefing was carried out for lengthy period averaging 16.7 minutes.
Cohort 2 with the implementation of adapted WHO checklist, initial time period had results similar to cohort 1, however, improvement was evident in terms of 75% reduction in delays, 85% increase in completion rate, briefing and de-briefing carried out effectively(average of 6.2 minutes), active involvement and communication between MDT was seen.
Cohort 3 with the use of the process and sustainment, CCL had achieved the set aims.
Conclusion
Use of adapted WHO checklist improve the safety and effectiveness considerably in CCL and also encourages the involvement and perception of MDT Staffs.
With the efficient and successful adaption for CCL, implementation of this process in other areas that are govern by NatSSIP will be beneficial such as interventional radiology, outpatients and endoscopy.
Overall, adapted WHO checklist can be used to standardise and harmonise as part of NatSSIP’s.
Aims
The aim is to achieve 100% completion of adapted WHO checklist and document of briefing and debriefing process for all patients undergoing procedure in CCL and increase the perception level of safety and effectiveness among Multi Disciplinary Team (MDT) staffs.
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I would like to acknowledge the MDT (CCL) for their time and support
Reference