Developing a safe procedure checklist for the cardiac catheterisation laboratory Royal Brompton and Harefield NHS Foundation Trust

The Royal Brompton and Harefield NHS Foundation Trust project team developed a standardised checklist and a 'team brief' for use before cardiac catheterisation laboratory (CCL) procedures.

Specific goals included:

• reducing morbidity and mortality following CCL procedures
• improving patient experience and staff satisfaction
• improving CCL productivity and workflow.

The checklist was based on the World Health Organization's safe surgery checklist and was split into three sections:

• sign in: pre-procedure checks carried out by a nurse prior to the patient being put on the table
• time out: a briefing delivered by the operator immediately prior to the start of the case
• sign out: a debrief from the operator, post-procedure checks and confirmation of case details for ward handover.

The team piloted the intervention in one of the Royal Brompton Hospital's five CCLs before extending it to the others. 

Who was involved

The project team included the lead clinician for clinical risk, a consultant cardiologist, a consultant anaesthetist, CCL nursing staff and the CCL manager.

Outcomes

• The target of 95% uptake of the checklist was exceeded.
• A reduction in procedure time for most cases where the checklist was used.
• Staff felt the CCL was safer, that they were more empowered to highlight potential safety issues and that they would like the checklist to be used if they ever needed an intervention themselves.
• Almost 60% of patients noticed staff implementing the checklist and felt safer because it was being used.

Challenges

The team encountered several non-adopters early on in the project. They successfully addressed this issue by providing regular direct feedback to the individuals concerned.

Supporting dissemination

This project has been given further support through a Spreading Improvement award to help disseminate learning and maximise the impact of the approach across the health service at a local, regional or national level.

Funding for this project was used to develop a structured programme of teamwork and human factors training to embed the checklist at a local level, and to host a national symposium to showcase learning, stimulate interest and motivate others to undertake similar work.

60 cath lab staff participated in the training day which included a facilitated discussion and training exercise to develop team working and communication skills. Two new initiatives were introduced; both of which came from the 'Improving Quality and Safety in Acute Cardiac Care’ Symposium (Mid-procedure sit reps and verbal confirmation of all instructions to administer drugs). These were well received and team members were given a chance to input into the way they might be used more routinely in the Cardiac Catheterisation Laboratory.

As a result of the symposium strong links were forged with both Nottingham Universities Hospital Trust and The Royal Berkshire Hospitals Trust, both of whom are keen to explore checklist use and simulation training. Plans for a multi-centre study are underway and the results of this project will form the basis of a justification for the study.

The team are planning another symposium in 2015.