title: Process Improvement in Thoracic Donor Organ Procurement: Implementation of a Donor Assessment Checklist.
abstract: BACKGROUND
  Donor organs are often procured by junior staff in stressful, unfamiliar environments where a single adverse event can be catastrophic. A formalized checklist focused on preprocedural processes related to thoracic donor organ procurement could improve detection and prevention of near miss events.
  
  
  METHODS
  A checklist was developed centered on patient identifiers, organ compatibility and quality, and team readiness. It went through five cycles of feedback and revision using a panel of expert procurement surgeons. Educational in-service sessions were held on the use of the checklist as well as best organ assessment practices. Near miss events before the survey were tallied by retrospective review of 20 procurements, and near misses after checklist implementation were prospectively recorded. We implemented the checklist for 40 donor lung and heart procurements: 20 from Cleveland Clinic and 20 from the University of Minnesota. A final survey assessment was used to determine ease of use.
  
  
  RESULTS
  Nine near miss events were reported in 20 procurements before use of the checklist. Thirty-one near miss events of 40 organ procurements were identified and potentially prevented by the checklist. Eighty-seven percent of fellows found the checklist to be unobtrusive to work flow, and 100% believed its use should be mandatory. Mortality was the same before and after implementation of the checklist despite increased patient volumes.
  
  
  CONCLUSIONS
  Implementation of a simple checklist for use during thoracic organ procurement uncovered a substantial number of near miss events. A preprocedural checklist for all thoracic organ transplants in the United States and abroad is feasible and would likely reduce adverse events.
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota. Electronic address: gloor@umn.edu.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Loor
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Shumway
authors.affiliation: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McCurry
authors.affiliation: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Suresh
authors.initials: S
authors.lastname: Keshavamurthy
authors.affiliation: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Syed
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Garry D
authors.initials: GD
authors.lastname: Weide
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: John R
authors.initials: JR
authors.lastname: Spratt
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Mazin
authors.initials: M
authors.lastname: Al Salihi
authors.affiliation: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Colleen G
authors.initials: CG
authors.lastname: Koch
mesh_terms: D057189:Checklist; D046148:Donor Selection; D016027:Heart Transplantation; D006801:Humans; D016040:Lung Transplantation; D000067491:Near Miss, Healthcare; D017064:Process Assessment, Health Care; D009927:Tissue and Organ Procurement; D014481:United States