Enhancing Surgical Safety in a Newly Established Cardiothoracic Center Using Failure Modes and Effects Analysis for Improving Outcomes in East Africa
Abstract:
Surgical safety is a major patient safety priority, especially in high-risk specialties such as cardiothoracic surgery. Newly established centers in low-resource settings may face amplified risks from communication failures, inconsistent perioperative processes, equipment readiness gaps, delayed blood product availability, and delayed recognition of postoperative deterioration. This quality improvement study evaluated the use of Failure Modes and Effects Analysis (FMEA) to improve surgical safety in a newly established cardiothoracic and vascular center in East Africa. A prospective 12-month quality improvement study was conducted at Kalkaal Hospital Cardiothoracic and Vascular Center, Mogadishu, Somalia. A multidisciplinary team mapped the perioperative pathway, identified potential failure modes, scored risks using severity, occurrence, and detection ratings, calculated Risk Priority Numbers, and prioritized corrective interventions. Baseline and post-intervention indicators included surgical safety checklist compliance, equipment-related operative delays, structured handoff compliance, postoperative deterioration escalation time, ICU readmissions, and safety culture indicators. Twenty-one potential failure modes were identified. Five high-priority risks were selected for intervention: inadequate patient verification, delayed recognition of postoperative deterioration, equipment readiness failure, communication failure during handoff, and checklist noncompliance. Interventions included a cardiothoracic-adapted checklist, equipment readiness bundle, standardized handoff tool, ICU early warning escalation algorithm, daily safety huddles, and briefing/debriefing protocols. Checklist compliance improved from 72% to 96%, equipment delay events reduced from 10 to 6 per month, structured handoff compliance improved from 61% to 92%, median escalation time improved from 42 to 18 minutes, and ICU readmissions were eliminated during observation. FMEA was feasible and useful for strengthening surgical safety in this setting.References:
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