Improving Patient Safety in the Cardiac Operating Room: Doing the Right Thing the Right Way, Every Time

The past 5 decades have seen an incredible advance in cardiac surgery knowledge, techniques, equipment, skill sets, and outcomes. Even as our average cardiac surgery patient becomes older with more significant cardiac disease and medical comorbidities, mortality continues to decrease. However, many of the deaths that do occur have been shown to be preventable. These preventable deaths are more often due to non-technical errors, such as communication failures, distractions, and disruptions, than to a failure of technical skill or knowledge. Further improvements in patient outcome require optimizing team performance, in both what the team does (evidence-based best practices) and how they do it (optimizing team performance, reduction of error, improved tools and technologies). Interventions such as formal team training, checklists, briefings and debriefings, cognitive aids, and handover tools have been shown to decrease disruptions and reduce patient mortality. Optimizing team performance will require adoption of a just culture, where errors are not met with “blame and shame” but as due to system hazards to be resolved, but where personal accountability is also present. The journey to habitual excellence should not be viewed as a draconian elimination of human error, but one of continuous optimization of team performance.