Utility and Feasibility of Intra- and Post-Operative Crisis Management Checklists in Cardiac Surgery
Sameer Hirji1, Christopher Tarola2, Houman Amirfarzan2, Steven Yule2,1, Jennifer Gabany2, Roger Dias2, Jacquelyn Quin2, Miguel Haime2, Marco Zenati2
1Brigham and Women's Hospital, MA; 2VA Hospital, West Roxbury, MA
Background: While preoperative safety checklists are widely utilized, intra and postoperative crisis management tools for time-critical settings in cardiac surgery are lacking.
Methods: This was a single-center prospective investigation in which 3-round modified Delphi-Method was used to develop a series of cognitive aids. In phase I, members of the cardiac surgery team were subject to training and simulation using various clearly outlined and situation-specific checklists. A survey was administered and evaluated using a 5-point Likert scale, with consensus defined as 70%. Phase 2 involves creation of a multi-platform checklist electronic application to help guide management in multiple crisis scenarios.
Results: 5 cognitive aids for cardiac surgery crisis scenarios were developed and validated, including Cardiopulmonary Bypass Pump Failure, Systemic Air Embolism, Venous Air Lock, Protamine Reaction and Heparin Resistance. 70% of the participants (N =9 of 13) had at-least 10 years of experience working in cardiac surgery. Almost all participants strongly agreed (response score 4.9 ± 0.3) that the crisis checklist will help them provide safer patient care. Phase 2 involves creation of check list app, with features such as dose picker for pertinent medications, and automatic code timer for charting.
Conclusion: Crisis checklists help to provide cognitive framework and standardized communication support for evidence-based perioperative management of emergent but rare crisis scenarios in high risk cardiac patients. Multi-platform app based checklist are also feasible.
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