Safety checklist use in the cardiac catheterisation lab: a UK survey

1. Safety checklist use in the cardiac catheterisation lab: a UK survey Figure 1: Survey methods 23 did not respond 85 of which were contacted 53 suitable for use in analysis 62 responded Gutjahr J1, Stables R2, Cahill TJ1 1. Department of Cardiology, High Wycombe Hospital, High Wycombe2. Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool 9 excluded did not fit criteria Rationale for surveyDespite numerous similarities between invasive procedures in the cardiac catheterisation laboratory and surgery in the operating theatre, the use of safety checklists in cardiology has not been analysed. To explore the uptake, utilization and perceived value of safety checklists in cardiology we surveyed a sample of UK cardiac catheterisation laboratories using a standardized questionnaire. ResultsOf 53 hospitals surveyed, 49 (92%) reported use of a safety checklist for patients undergoing a procedure in the cardiac cath lab; of these, 19 (39%) used a locally designed cath lab checklist, 12 (24%) used the WHO Surgical Safety Checklist and 2 (4%) used the RCR Interventional Radiology Safety Checklist. Another 16 centres (33%) used a combination of both a local checklist with the WHO checklist (see Figure 2). Checklist compliance varied by procedure (see Figure 3). 1 the form was inadequately filled in 4 centres did not perform diagnostic angiography or PCI 4 were not NHS hospitals The use of safety checklists prior to surgery has become an international standard of care (1); the WHO Surgical Safety Checklist has reduced complications and mortality in surgical patients (2). A checklist was used without exception for diagnostic angiography in 89% (47/53) of centres, for elective angioplasty in 81% (35/43), but for primary angioplasty for ST elevation myocardial infarction (STEMI) in only 58% (21/36) of centres. WHO surgical safety checklist (1) It has played a key role in improving patient safety addressing both technical (administration of antibiotics) and non-technical (team introductions) of patient care. Communication errors are a major cause of adverse events in hospital teams (3), and the incorporation of the nontechnical element of the checklist as a communication tool has reduced communication mistakes (4) and errors due to human factors (5). It has also been show to be cost effective (6). Only 30% (16/53) routinely conducted a team brief. Staff perceived safety checklists to be highly valuable, with 81% agreeing that checklist use improved communication. MethodsWe surveyed a sample of UK cardiac catheterisation laboratories using a standardized questionnaire, completed by post or by telephone. For each centre, a nurse, doctor, physiologist or radiographer was asked about the use and design of safety checklists in that hospital, adherence and completion of the checklist, the team brief, and attitudes towards checklists in the catheterisation lab. ConclusionRapid adoption of safety checklists in cardiology is evident; but there is wide variation in the design of checklists being used. Although checklists are regarded as highly valuable by staff, completion is not universal, particularly in the emergency setting of primary angioplasty for STEMI. Many hospitals are using both the WHO checklist alongside a second checklist to include cardiology-specific steps. Development of a standardized cardiology-specific safety checklist might eliminate this inefficiency and increase relevance and compliance. Implications on patient safetyThis survey has explored current practice in different cardiac catheterisation labs regarding uptake and use of patient safety checklists, in addition to assessing the perceived value of team briefing and checklist use by staff. The use of the WHO safety checklist has improved patient safety in surgery by providing a structure and international standardization, while breaking through communication barriers and empowering all members of the team. Our survey identifies that checklists are perceived as highly valuable by cardiology staff, but that a requirement for multiple checklists (to include cardiology-specific steps alongside WHO) and emergency cases represent current challenges to implementing effective checklist use in the cath lab. Optimization of safety checklist use for the cardiac catheterisation laboratory may be required to achieve the benefits reported in surgery. To do this research, exploring the specific requirements of such a checklist, in the specific environment of a cath lab compared to the surgical operating theatre, needs to be explored. Once such a checklist is developed the potential to run it at a national level should aid standardisation of patient safety across the country. We used the surveys of 53 centres (see figure 1 Survey Methods) of which 16 (30%) were tertiary centres and 43 (81%) performed coronary angioplasty. Literature cited (1) World Alliance for Patient Safety . WHO surgical safety checklist and implementation manual. World Health Organisation. First edition. United States of America http://www.who.int/patientsafety/safesurgery/ss_checklist/en/ Accessed 10/05/2014. (2) Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 260:491–9. http://www.nejm.org/doi/full/10.1056/NEJMsa0810119 Accessed 10/05/2014 (4) Lingard L, Regehr G, Orser B, et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg 2008;143:12–17 http://archsurg.jamanetwork.com/article.aspx?articleid=401280 Accessed 10/05/2014 (3) Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med 2004;79 (2) 186- 194. file:///C:/Users/Lou/Documents/Downloads/Communication_Failures__An_Insidious_Contributor.19.pdf Accessed 10/05/2014 (5) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13(SUPPL 1):i85–90 http://qualitysafety.bmj.com/content/13/suppl_1/i85.full.pdf+html Accessed 10/05/2014 (6) Semel ME, Resch S, Haynes AB, et al. Adopting a surgical safety checklist could save money and improve the quality of care in US hospitals. Health Aff (Millwood) 2010;29:1593–9. http://content.healthaffairs.org/content/29/9/1593.full Accessed 10/05/2014 Conflict of interests: None declared Further information: jessgutajhr@hotmail.co.uk