title: FIASCO II failure to achieve a satisfactory cardiac outcome study: the elimination of system errors.
abstract: OBJECTIVE
  Death in low-risk cardiac surgical patients provides a simple and accessible method by which modifiable causes of death can be identified. In the first FIASCO study published in 2009, local potentially modifiable causes of preventable death in low-risk patients with a logistic EuroSCORE of 0-2 undergoing cardiac surgery were inadequate myocardial protection and lack of clarity in the chain of responsibility. As a result, myocardial protection was improved, and a formalized system introduced to ensure clarity of the chain of responsibility in the care of all cardiac surgical patients. The purpose of the current study was to re-audit outcomes in low-risk patients to see if improvements have been achieved.
  
  
  METHODS
  Patients with a logistic EuroSCORE of 0-2 who had cardiac surgery from January 2006 to August 2012 were included. Data were prospectively collected and retrospectively analysed. The case notes of patients who died in hospital were subject to internal and external review and classified according to preventability.
  
  
  RESULTS
  Two thousand five hundred and forty-nine patients with a logistic EuroSCORE of 0-2 underwent cardiac surgery during the study period. Seven deaths occurred in truly low-risk patients, giving a mortality of 0.27%. Of the seven, three were considered preventable and four non-preventable. Mortality was marginally lower than in our previous study (0.37%), and no death occurred as a result of inadequate myocardial protection or communication failures.
  
  
  CONCLUSIONS
  We postulate that the regular study of such events in all institutions may unmask systemic errors that can be remedied to prevent or reduce future occurrences. We encourage all units to use this methodology to detect any similarly modifiable factors in their practice.
authors.affiliation: Cardiothoracic Surgical Unit, Papworth Hospital, Cambridge, UK.
authors.forename: Shakil
authors.initials: S
authors.lastname: Farid
authors.forename: Aravinda
authors.initials: A
authors.lastname: Page
authors.forename: David
authors.initials: D
authors.lastname: Jenkins
authors.forename: Mark T
authors.initials: MT
authors.lastname: Jones
authors.forename: Darren
authors.initials: D
authors.lastname: Freed
authors.forename: Samer A M
authors.initials: SA
authors.lastname: Nashef
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002423:Cause of Death; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008485:Medical Audit; D019300:Medical Errors / Q000401:mortality* / Q000517:prevention & control; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Perioperative care; Risk analysis/modelling; Statistics; Surgical complications