Downloaded from http://heart.bmj.com/ on November 21, 2015 - Published by group.bmj.com
PostScript
CORRESPONDENCE
Where are the surgeons? A safety opportunity missed? To the Editor, The introduction of a patient safety checklist by Cahill et al 1 is a welcome addition for interventional cardiologists and is a concept practiced by surgeons in all disciplines for a number of years since the original WHO patient safety checklist was proven to be of benefit in a global and multidisciplinary setting.2 The European Association for Cardiothoracic Surgery embraced this ideal in 20123 with the publication of safety checklists that were specific to the nature of surgery undertaken, comprehensive and failsafe. The purpose of checklists is to ensure patient safety, confirming that the team is prepared for the procedure ahead and that all are ready for any eventuality. The checklist published by Cahill et al has an obvious omission in this regard—ensuring that those involved in the procedure are aware of the contact details and availability of a cardiac surgeon if needed. While less important (but sometimes needed) in coronary interventions where surgical complications are rare, transcatheter aortic valve implantation (TAVI) and other procedures such as pacing lead extraction may require the attendance of the cardiac surgical team more frequently in the event of major issues arising, and preparedness is crucial in emergency situations. The British Cardiovascular Intervention Society/Society of Cardiothoracic Surgeons Position Statement on TAVI (2009) man-
1434
dates the need for surgical cover on site and immediate access to cardiopulmonary bypass. There is an opportunity in the checklist for the cardiology team to check that they have current contact and availability details for the cardiac surgical team so that, if required, help can be summoned without delay. With more and more TAVI procedures being performed transfemorally, cardiac surgeons are not always physically present during procedures and robust cover arrangements need to be in place and details of cover confirmed. The checklist is the ideal opportunity for this to be done and avoids unnecessary delays when minutes count. The omission of a specific place on the checklist to ensure that such details are known misses an essential step in ensuring patient safety. However, as is clear from the introduction of safety checklists in the surgical arena, the most significant hurdle to overcome is one of apathy following their introduction. If this can be overcome and the motivation of those using it maintained through strong leadership, then this will surely be an effective contribution to patient safety. Stephen Clark Correspondence to Stephen Clark, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
Heart September 2015 Vol 101 No 17
To cite Clark Stephen. Heart 2015;101:1434. Published Online First 2 March 2015
▸ http://dx.doi.org/10.1136/heartjnl-2014-306927 Heart 2015;101:1434. doi:10.1136/heartjnl-2015-307659
REFERENCES 1
2
3
Cahill TJ, Clarke SC, Simpson IA, et al. A patient safety checklist for the cardiac catheterisation laboratory. Heart 2015;101:91–3. 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;360:491–9. Clark SC, Dunning J, Alfieri OR, et al. EACTS guidelines for the use of patient safety checklists. Eur J Cardiothorac Surg 2012;41:993–1004.
Downloaded from http://heart.bmj.com/ on November 21, 2015 - Published by group.bmj.com
Where are the surgeons? A safety opportunity missed? Stephen Clark Heart 2015 101: 1434 originally published online March 2, 2015
doi: 10.1136/heartjnl-2015-307659 Updated information and services can be found at: http://heart.bmj.com/content/101/17/1434.2
These include:
References Email alerting service
This article cites 3 articles, 2 of which you can access for free at: http://heart.bmj.com/content/101/17/1434.2#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript
CORRESPONDENCE
Where are the surgeons? A safety opportunity missed? To the Editor, The introduction of a patient safety checklist by Cahill et al 1 is a welcome addition for interventional cardiologists and is a concept practiced by surgeons in all disciplines for a number of years since the original WHO patient safety checklist was proven to be of benefit in a global and multidisciplinary setting.2 The European Association for Cardiothoracic Surgery embraced this ideal in 20123 with the publication of safety checklists that were specific to the nature of surgery undertaken, comprehensive and failsafe. The purpose of checklists is to ensure patient safety, confirming that the team is prepared for the procedure ahead and that all are ready for any eventuality. The checklist published by Cahill et al has an obvious omission in this regard—ensuring that those involved in the procedure are aware of the contact details and availability of a cardiac surgeon if needed. While less important (but sometimes needed) in coronary interventions where surgical complications are rare, transcatheter aortic valve implantation (TAVI) and other procedures such as pacing lead extraction may require the attendance of the cardiac surgical team more frequently in the event of major issues arising, and preparedness is crucial in emergency situations. The British Cardiovascular Intervention Society/Society of Cardiothoracic Surgeons Position Statement on TAVI (2009) man-
1434
dates the need for surgical cover on site and immediate access to cardiopulmonary bypass. There is an opportunity in the checklist for the cardiology team to check that they have current contact and availability details for the cardiac surgical team so that, if required, help can be summoned without delay. With more and more TAVI procedures being performed transfemorally, cardiac surgeons are not always physically present during procedures and robust cover arrangements need to be in place and details of cover confirmed. The checklist is the ideal opportunity for this to be done and avoids unnecessary delays when minutes count. The omission of a specific place on the checklist to ensure that such details are known misses an essential step in ensuring patient safety. However, as is clear from the introduction of safety checklists in the surgical arena, the most significant hurdle to overcome is one of apathy following their introduction. If this can be overcome and the motivation of those using it maintained through strong leadership, then this will surely be an effective contribution to patient safety. Stephen Clark Correspondence to Stephen Clark, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
Heart September 2015 Vol 101 No 17
To cite Clark Stephen. Heart 2015;101:1434. Published Online First 2 March 2015
▸ http://dx.doi.org/10.1136/heartjnl-2014-306927 Heart 2015;101:1434. doi:10.1136/heartjnl-2015-307659
REFERENCES 1
2
3
Cahill TJ, Clarke SC, Simpson IA, et al. A patient safety checklist for the cardiac catheterisation laboratory. Heart 2015;101:91–3. 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;360:491–9. Clark SC, Dunning J, Alfieri OR, et al. EACTS guidelines for the use of patient safety checklists. Eur J Cardiothorac Surg 2012;41:993–1004.
Downloaded from http://heart.bmj.com/ on November 21, 2015 - Published by group.bmj.com
Where are the surgeons? A safety opportunity missed? Stephen Clark Heart 2015 101: 1434 originally published online March 2, 2015
doi: 10.1136/heartjnl-2015-307659 Updated information and services can be found at: http://heart.bmj.com/content/101/17/1434.2
These include:
References Email alerting service
This article cites 3 articles, 2 of which you can access for free at: http://heart.bmj.com/content/101/17/1434.2#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
