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• Where are the Surgeons? A Safety Opportunity Missed
  Stephen Clark
  Published on: 23 November 2015

• Published on: 23 November 2015

  Where are the Surgeons? A Safety Opportunity Missed

  • Stephen Clark, Professor of Cardiothoracic Surgery

  The introduction of a Patient Safety Checklist 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 (1). The European Association for Cardiothoracic Surgery embraced this ideal in 2012 (1) with the publication of safety check...

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  The introduction of a Patient Safety Checklist 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 (1). The European Association for Cardiothoracic Surgery embraced this ideal in 2012 (1) with the publication of safety checklists which 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, 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 BCIS/SCTS Position Statement on TAVI (2009) mandates 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.

  1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491- 499. 2. Clark S.C., Dunning J., Alfieri O.R., Elia S., Hamilton L.R., Kappetein A.P., Lockowandt U., Sarris G.E., Kolh P.H. EACTS Guidelines for the Use of Patient Safety Checklists. European Journal of Cardiothoracic Surgery 2012; 41 (5): 993-1004

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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