A Detailed Checklist in Cardio-Thoracic Surgery: The Isala safety Check

Abstract

In various fields of complex environments, checklists have been introduced, mainly to improve procedural related aspects like logistics, personnel support and equipment. However, in order to pursue better outcome, major patient-related factors may be likewise important to check immediately before surgical procedures. Therefore, a specific checklist, the Isala Safety Check, was developed in a high-volume cardio-thoracic surgery unit. It concerns a short list focusing on the presence of potential sources for peri-operative complications, including actual information of cardiac function, pulmonary comorbidities, renal impairment, neurological condition, predisposing factors for postoperative infections and risk of transfusion. Special attention is paid to the on-site information obtained by standard transesophageal echo, particularly the visualization of the condition of the ascending aorta. After anesthesia induction, but just before skin incision, these items are discussed in the presence of the entire team, by means of a checklist. Consensus is achieved to whether there are any adaptations required for the operation. This method has shown to increase team awareness, stimulate communication and may improve outcome. Details of the Isala Safety Check and the application of this checklist in routine and emergency cardiac surgery are discussed.