Abstract
Objectives
To evaluate the impact of adherence to the cardiac surgical checklist on mortality at the teaching hospital.
Methods
A retrospective cohort study after the implementation of the cardiac surgical safety checklist in a reference hospital in Latin America. All patients undergoing coronary artery bypass surgery and/or heart valve surgery from 2013 to 2019 were analyzed. After the implementation of the project InCor-Checklist “Five steps to safe cardiac surgery” in 2015, the correlation between adherence and completeness of this instrument with surgical mortality was assessed. The EuroSCORE II was used as a reference to assess the risk of expected mortality for patients. Cross-sectional questionnaires were during the implementation of the InCor-Checklist. To perform the correlation, Pearson’s coefficient was calculated using R software.
Results
Since 2013, data from 8139 patients have been analyzed. The average annual mortality was 5.98%. In 2015, the instrument was used in only 58% of patients; in contrast, it was used in 100% of patients in 2019. There was a decrease in surgical mortality from 8.22% to 3.13% for the same group of procedures. The results indicate that the greater the checklist use, the lower the surgical mortality (r = 88.9%). In addition, the greater the InCor-Checklist completeness, the lower the surgical mortality (r = 94.1%).
Conclusion
In the formation of the surgical patient safety culture, the implementation and adherence to the InCor-Checklist “Five steps to safe cardiac surgery” was associated with decreased mortality after cardiac surgery.
HIGHLIGHTS
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Checklists avoid human errors and are commonly used in high-reliability industries.
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The “InCor Checklist” was associated with decreased mortality over time.
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Adherence, completeness, and sustainability within public policies are necessary.
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