WINNER - Impact of implementation of an intra-operative checklist to reduce re-operation for bleeding and blood transfusion

Swansea Bay University Health Board

‘Return to Theatre’ for bleeding and tamponade is a marker of adverse clinical outcome and resource utilisation. Published literature and national databases report an incidence rate of between 2-8%. Following recent review from GIRFT (getting it right the first time), reducing the incidence of re-exploration for bleeding following cardiac surgery has been one of the key priorities to improve patient care in Swansea Bay UHB. On 1st August 2021 change was introduced – ‘Intraoperative haemostasis check list’.

A locally developed intra-operative checklist, including identify bleeding on various surgical sites, correction of anaemia, coagulation profile and platelet function by TEG/Rotem, was introduced. As per recommendation from GIRFT report, all cardiac surgeons, specialist registrars, anaesthetist consultants and trainees were involved in the checklist performed at the end of each case. This required meticulous identification of surgical sites and non-surgical causes of bleeding prior to chest closure following all cardiac surgical operations.

The implementation of checklist has resulted in a reduction in the incidence of re-operation for bleeding by 66%, a significant reduction in the use of blood products per patient, and also an associated reduction in critical care utilisation.

This has led to a significant quality improvement in terms of patient safety, efficient use of limited resources and effective reduction in rate of re-operation for bleeding. There is a need to maintain a consistently low rate of re-exploration for bleeding, in line with the best centres nationally and internationally and reduce the use of blood products locally – a very precious resource.

Plans are underway to roll out a simple and reproducible intra-operative checklist (haemostasis) to be used in every cardiac surgery case performed in Morriston Hospital.

Sobaran Sharma

sobaran.sharma@wales.nhs.uk