Procedural Checklist Research Articles

Development and Review of the Chest Tube High-Feedback Educational Simulation Trainer (CHEST).

Emergency medicine physicians must receive training in chest tube placement. This life-saving skill must be completed quickly and competently to prevent morbidity and mortality. Training on live patients is no longer an appropriate or acceptable practice. Current training devices have been noted to be costly, may be difficult to store, or may require time-consuming cleanup or setup. Fifteen Chest tube High-feedback Educational Simulation Trainers were created. Frames were made from wood and PVC, and soft tissue layers were designed using silicone and polyurethane foam. Nine training sites volunteered to test the model and provided feedback on the acceptability of the task trainer for skill training. Survey findings demonstrated that the model was realistic for teaching, portable, and was easy to use and maintain. In our model, the outer skin was noted to tear easily, thus limiting its use for suture training. Overall programs reported that they would use this model if it was available for the same or lower cost than current models. An inexpensive task trainer was created that was easy to store, quick to set up, durable, easy to clean, and rated as effective at training the skill of chest tube insertion.

Incidence of an Astronaut Not Sealing the Pressure Garment Visor on Reentry

Audiovisual records of a Project Mercury pilot's activities during an orbital flight indicate that his visor was left open during reentry and descent to the sea surface, phases of flight during which cabin pressure loss was to be mitigated by suit pressurization; however the suit could not have been pressurized with the visor open. Thus, for a presentlyunknown reason, a critical safety step—sealing the visor and making a pressure suit integrity test before re-entry—was overlooked in this flight, a fact itself unreported in any flight review or historical documents known to the author. The lesson is clear: even a highly-motivated, federally-funded project remains at base a collaboration of individuals, the project only being as strong as the proverbial weakest link. Attention to development of thorough and unambiguous procedural checklists is reiterated.

Lausanne checklist for safe stereotactic radiosurgery.

Stereotactic radiosurgery (SRS) is increasingly used as a minimally invasive alternative in many neurosurgical conditions, including benign and malignant tumors, vascular malformations, and functional procedures. As for any surgical procedure, strict safety guidelines and checklists are necessary to avoid errors and the inherent unnecessary complications. With regard to the former, other groups have already reported human and/or technical errors. We describe our safety checklist for Gamma Knife radiosurgical procedures. We describe our checklist protocol after an experience gained over 1500 radiosurgical procedures, using Gamma Knife radiosurgery, performed over a period of 8years, while employing the same list of items. Minor implementation has been performed over time to address some safety issues that could be improved. Two types of checklist are displayed. One is related to the indications when a specific tissue volume is irradiated, including tumors or vascular disorders. The second corresponds to functional disorders, such as when the dose is prescribed to one specific point. Using these checklists, no human error had been reported during the past 8years of practice in our institution. The use of a safety checklist for SRS procedures promotes a zero-tolerance attitude for errors. This can lower the complications and is of major help in promoting multidisciplinary cooperation. We highly recommend the use of such tool, especially in the context of the increased use of SRS in the neurosurgical field.

Analysis of the Pre-Primary School Children Assessment Procedure in Nigeria

The issue of assessment is critical to children’s development. The adoption of suitable assessment tools/strategies would aid the process of judgment and decision making on children’s developmental milestones and learning. Therefore, this study examined the assessment procedure adopted for the pre-primary school children in Nigeria and to determine their developmental appropriateness to children. A descriptive survey design was adopted for the study. One hundred and sixty-two public schools were purposively selected from two southwestern states in Nigeria based on the availability of pre-primary class(es). One instrument entitled ‘Assessment Procedure Checklists (APC)’ was used for data collection. The instrument has two sections with section A, focusing on the demographic variables of the number of early childhood education classes available, number of teachers, number of children and teachers’ qualification. Section B assessed the type(s) of the assessment tool(s)/strategies adopted, when and how the procedure was carried out. Data were analyzed using simple percentages. Results indicated that the assessment procedure for pre-primary children in public schools was not developmentally appropriate for the children as paper and pencil’s type is the prominent one. It is therefore recommended that teachers should be given training and retraining on assessment procedures that are developmentally appropriate and would help to make decisions on children.

Using Performance Management to Implement a Preprocedural Checklist for Gastrointestinal Endoscopy Procedures.

Providing safe patient care is an important focus of healthcare organizations. In surgical settings, mortality rates have been shown to decrease from 1.5% to 0.8% and complication rates from 11% to 7% when institutions use the World Health Organization's Surgical Safety Checklist. In our hospital-based gastrointestinal endoscopy unit, we recognized that inconsistencies in the preprocedural readiness of patients were causing inefficiencies in scheduling. Therefore, we initiated a quality improvement project to determine whether a preprocedural checklist and positive reinforcement for the nurses in the units could improve endoscopy preparation of patients. The checklist was used to prepare patients and to facilitate nurse-to-nurse communications. We completed a 6-week pilot study (preintervention and postintervention). The results demonstrated the importance of having nurses use a checklist in hospital care units to adequately prepare patients and to accurately communicate patient readiness before gastrointestinal endoscopy procedures. Nursing leadership used positive reinforcement as a strategy to encourage the use of the preprocedural checklist. A postpilot survey of nurses involved in the study show that the preprocedural checklist enhanced care and communication between the patient care units and resulted in direct and indirect benefits for nurses and patients.

Preparation is the Only Shortcut You Need in Surgery: A Guide to Surgical Rehearsals for Hand and Upper Extremity Transplantation.

As upper extremity transplantation is becoming more accepted worldwide, the demand for a fresh tissue cadaveric training model for this procedure is increasing and necessary to assure surgical success. Surgical rehearsals can decrease operative time, improve technique, and reduce errors made on the actual day of surgery. The purpose of this article is to describe a method for surgical rehearsal of upper extremity transplantation using cadaveric specimens based on the clinical experience of an academic institution with an active transplantation program. The logistics of rehearsal setup, equipment, and modified version of procedural checklists are described.

UK national audit of safety checks for radiology interventions.

To reaudit the use of safety checklists in radiology departments in NHS departments throughout the UK. This audit was performed on behalf of The Royal College of Radiologists Audit Committee in 2016 and was sent to radiology audit leads at every NHS department in the UK to determine the use of safety checks in various modalities and subspecialties. Free-form text boxes gathered data on problems with checklist implementation. 109/177 (62%) trusts responded. 48% of respondents used safety checklists for all radiological procedures in all modalities. 50% used checklists for some procedures. 2% did not use a checklist. Checklist use had increased since the previous audit (98% 2016, compared to 94% in 2012) but implementation for different procedures remains variable. For example, in ultrasound-guided fine needle and breast stereotactic procedures (49%), use has not increased since 2012. Reasons for not using checklists include a perception that intervention suite checklists were not appropriate for minor procedures and the limited flexibility of radiology information systems. The limitations of checklists are discussed. Our reaudit shows that in spite of increased implementation, use of safety checks is variable. Local ownership and radiology information system flexibility are needed to support the culture of safety processes in radiology departments.

Robotic Emergencies: Are You Prepared for a Disaster?

The surgical robot is a complex tool that surgeons use to perform a variety of minimally invasive procedures. Perioperative nurses play a vital role in patient care when the surgical robot is in use; a key goal is to ensure optimal patient safety while using this complex, innovative technology. Robotics proficiency requires extensive and continuous education for all members of the perioperative team. Successful robotics programs should employ focused initiatives and a multidisciplinary approach for the prevention and management of robotic emergencies. To facilitate the appropriate response and minimize patient harm, members of the surgical team should be aware of their expected roles and responsibilities. The robotics program should have specific procedures and protocols, such as a critical event checklist and an emergent conversion-to-open procedure checklist that define each surgical team member's task during an emergency, and robust ongoing education, skills review, and competency validation for robotics team members.

Development and Validation of Simulation-Based Procedural Checklists for Evaluation of Neonatal Nurse Practitioner Performance

Neonatal nurse practitioner (NNP) procedural competence is essential. Procedural simulation provides opportunity to practice high-risk, low-frequency procedures and helps improve skill retention. A formal procedural simulation experience was created in an attempt to provide sufficient experience for NNPs. While preparing for the simulation experience, the group recognized the lack of validated competency metrics for most neonatal intensive care unit (NICU) procedures. The purpose of this study was to create and validate procedural checklists measuring competence of NNPs participating in simulated performance of 9 high-risk NICU procedures. IRB approval was obtained and NNPs agreed to data collection. A self and peer assessment tool was developed and distributed to NNPs, nurses, and neonatologists to gather a baseline perception of procedural competency. Procedural checklists were then developed to measure/assess individual skills against a standard. Benchmark videos were created to demonstrate the standard approach to procedural performance. Each procedural skill performed by the NNP participant was scored by 3 individual evaluators: once in real time and twice by video recording analysis. A Cronbach α was used to measure the reliability and validity of the procedural checklists. Comparison was made between live grading and video-based grading scores using analysis of variance. Difference between grading modalities was less than 3% and nonsignificant for 8 of 9 procedures. No significant difference was found between individual graders for any of the skills being evaluated and suggested high interrater reliability of the checklists. Objective, standardized procedural checklists are valid tools to evaluate NNP procedural skills in simulation. Procedural simulation experiences help strengthen skills, improve performance, and possibly improve patient outcomes.

The adaption and implementation of the WHO Surgical Safety Checklist for dental procedures.

Objective: The objective of this study is to systematically adapt the WHO Surgical Safety Checklist for use in dentistry. Study design: Expert consensus panel. Setting, materials and methods: Using the 'WHO adaptation guidance', the WHO Surgical Safety Checklist was assessed and adapted by an expert panel using the Delphi technique. The newly developed checklist was piloted on a sample of 40 patients who were referred for the placement of dental implants at an implant referral centre. Results: The WHO Dental Safe Surgery Checklist was developed. Conclusions: This study presents an adaptation of the WHO Surgical Safety Checklist for use in dentistry. The whole practice team needs to be trained on the use of the WHO checklist (as per the WHO implementation guidelines). It needs systematic implementation, for every episode of dental surgery including dental extractions, minor oral surgery (MOS) and implant surgery, as part of a culture that is centred around patient safety. If appropriately implemented, this checklist could be a valuable safety barrier to mitigate the potential consequences of human error.

The emergency surgical airway: Bridging the gap from quality outcome to performance improvement through a novel simulation based curriculum

BackgroundEmergency surgical airway is a low frequency, high risk clinical scenario. Implementing a simulation-based curriculum may bridge the gap in surgical training and address quality assurance/performance improvement (QAPI) needs. MethodsWe designed and implemented an Advanced Surgical Airway Curriculum (ASAC) modeled after proficiency-based training. General Surgery residents and student nurse anesthetists were enrolled. Evaluation consisted of cognitive tests, procedure checklists and questionnaire. ResultsIn total, 78 participants successfully completed the ASAC. Trainees agreed that the curriculum provided the cognitive and psychomotor skills necessary to perform both an open and needle cricothyroidotomy. ConclusionsIn the age of increased patient safety concerns, QAPI initiatives can serve as a driver for simulation-based training curricula, with particular focus on individualized, active learning. This may be particularly useful in high risk, low frequency scenarios in which the traditional method of “See one, Do one, Teach one,” is not feasible.

Technology Update: New Instrumented Docking Gun System Maximizes Perforating Performance

Technology Update Accidental detonation of a perforating gun at surface can have catastrophic consequences. To decrease risks, layers of procedural controls have been implemented to reduce the inadvertent application of power caused by human error, stray voltage, or the presence of radio frequency (RF) energy. Explosives handling procedures and controls, such as locking out the firing panel and acquisition system, are used to mitigate the human error risk. Mitigating RF risks requires establishing RF-free exclusion zones, with all RF transmissions shut down. Exclusion zones are effective, but adhering to them relies on strict procedural controls. With increased industry and personal reliance on RF transmitters, such as cellular phones, RF silence is becoming more difficult to achieve. Although RF-immune initiators were introduced more than 20 years ago to allow wellsite operations to continue without RF silence imposed, their complex initiation technologies require high power levels, which improve the safety margin to stray volt-age but significantly reduce overall system reliability. Perforating has always been a hands-on operation that relies on supervisor experience. Over the last decade, perforating reliability has continued to improve as service companies and operators have implemented detailed training programs, procedural checklists, and advanced hardware. However, these reliability improvements have begun to plateau, acting as an impetus to develop new perforating systems that would be more effective than procedural controls in addressing the main causes of perforating misruns: damaged or improper wiring, mechanical seal failures, and initiator malfunctions. Plug-In Design With Built-In Safety With a focus on resolving these issues, Schlumberger developed the Tempo instrumented docking perforating gun system—the industry’s first perforating system that fully integrates a plug-in gun with real-time advanced downhole measurements for monitoring and confirming operations to mitigate risk while increasing safety, reliability, and efficiency (Fig. 1). Created for all environments, the system uses modularized initiators combined with RF filtering mechanisms and an addressable switch to provide an enhanced level of safety to operations. Proprietary docking components are the key element of the gun system’s plug-in design. They streamline assembly and eliminate the major cause of perforating misfires: technique-sensitive crimping and wiring. The initiator can be plugged into a perforating gun by using simple mechanical and electrical connections without requiring complicated assembly. The new system eliminates all complex field wiring connections and crimping, which simplifies the arming process that has a direct impact on both wellsite efficiency and reliability.

Paracentesis Simulation: A Comprehensive Approach to Procedural Education.

Structured procedural education and assessment of competency are growing needs for residency and fellowship programs. Simulation is a useful way to learn, experience, and practice procedural skills with competence. Paracentesis is a common procedure encountered in internal medicine. This educational resource for paracentesis education includes didactics, cases, and assessments to address cognitive skills, a simulation experience to address psychomotor procedural skills, and an entrustment-based assessment tool. Prior to the simulation, learners completed preprocedural didactics and self-assessments. Utilizing a paracentesis trainer, ultrasound, and paracentesis kit, the case of a 46-year-old male with ascites in need of a paracentesis was presented. During the simulation, learners initially performed a paracentesis step by step, with assistance and feedback from the case instructor. This was immediately followed by paracentesis without assistance, where the instructor evaluated the learners with an assessment tool encompassing a procedural checklist, global skill assessment scale, and entrustment scale. Afterwards, learners completed case-based reviews and returned to the simulation lab several months later to repeat an unassisted paracentesis. The curriculum was used with internal medicine and medicine-pediatric residents of all training levels. To date, over 120 residents have completed the curriculum. Residents reported an increase in self-confidence and competence using ultrasound to identify ascites and performing a paracentesis. Learners provided positive feedback. This curriculum offers the opportunity for both cognitive and psychomotor paracentesis education in a low-risk simulation environment. The comprehensive strategy with didactics, cases, and multiple simulations is designed to promote knowledge and skill retention.

Colonoscopy quality requisites for selecting surveillance intervals: A World Endoscopy Organization Delphi Recommendation.

Different post-polypectomy guidelines underscore the need for high-quality baseline colonoscopy before appropriate surveillance recommendations can be made. Standards for colonoscopy practice have been advocated by gastrointestinal societies. Our aims were to define standards for the procedural practice of colonoscopy in this particular setting of surveillance and to generate a colonoscopy procedural quality checklist that could be implemented in clinical practice. This study was based on the Delphi process methodology. The baseline questionnaire included 12 domains and 56 individual statements. A total of three rounds were carried out between September 2015 and March 2016 until consensus or lack of consensus was reached. In total, consensus was reached on 27 statements in nine domains. High levels of agreement and consensus were reached that: (i) colonoscopy should be considered complete only if the whole cecum has been inspected, including the ileocecal valve and the appendiceal orifice (agreement score 4.63; degree of consensus 82%); (ii) quality of the bowel preparation should always be reported (agreement score 4.9, degree of consensus 94%); and (iii) it is preferable to use a segmental validated scale (agreement score 4.36, degree of consensus 86%). Consensus was also reached regarding multiple statements related to documentation of polyps and their resection. Finally, a colonoscopy quality checklist was drafted. Consensus on different statements regarding quality of colonoscopy has been reached. Based on this consensus, we propose a colonoscopy quality checklist that would be helpful for post-polypectomy surveillance recommendations.

Transoesophageal echocardiography current practice in France: A multicentre study

Few data are available on the application of transoesophageal echocardiography (TOE) recommendations in daily practice. To evaluate TOE practice based on echocardiography societies' guidelines, and to determine complication rates and factors associated with patient feelings. Between April and June 2017, we prospectively included all consecutive patients referred to 14 French hospitals for a transoesophageal echocardiogram (TOE). A survey was taken just after the examination, which included questions about pre-procedural anxiety, and any pain, unpleasant feeling or breathing difficulties experienced during the examination. Overall, 1718 TOEs were performed, mainly for stroke evaluation. A standardized operating procedure checklist was completed in half of the patients before the examination. TOE was unpleasant for 62.4% of patients, but was stopped for agitation or intolerance in 3.5 and 1.4% of cases, respectively. We observed one severe complication (pulmonary oedema). The mean TOE duration was short (9.2±4.6minutes), but was longer with residents than with more experienced physicians (11±4.7 vs. 8.8±4.7minutes for junior physicians [P=0.0027]; vs. 8.9±4.8minutes for senior physicians [P=0.0013]; and vs. 7.5±4.1minutes for associate professors/professors [P<0.0001]). The visual analogue scale (VAS) score after TOE was good (8.3±1.7 out of 10), and was better in patients with general anaesthesia (GA) than in those without GA (9.3±0.9 vs. 8.1±1.7; P<0.0001). In patients without GA, the VAS score was similar with and without local anaesthesia (8.1±1.7 vs. 8.2±1.6; P=0.19). After multivariable adjustment, absence of anxiety before TOE and greater operator experience were consistently associated with a higher VAS score. TOE is safe, with a low rate of complications and few stops for intolerance. A shorter TOE duration and better patient feelings were observed for experienced operators, highlighting the importance of the learning curve, and paving the way for teaching on a TOE simulator.

Retention of cricothyrotomy skills by paramedics using a wire guided technique

IntroductionCricothyrotomy may be necessary for airway management when a patient's airway cannot be maintained through standard techniques such as oral airway placement, blind insertion airway device, or endotracheal intubation. Wire-guided cricothyrotomy is one of many techniques used to perform a cricothyrotomy. Although there is some controversy over which cricothyrotomy technique is superior, there is no published data regarding long term retention rates. The purpose of this study is to determine whether ground based paramedics can be taught and are able to retain the skills necessary to successfully perform a wire-guided cricothyrotomy. MethodsThis retrospective study was performed in a suburban county with a population of 160,000 with 23,000 EMS calls per year. Participants were ground-based paramedics who were taught wire-guided cricothyrotomy as part of a standardized paramedic educational update program. After viewing an instructional video, the paramedics were shown each the steps of the procedure on a simulation model, using a low fidelity task trainer previously developed to train emergency medicine residents. Using a 16 step procedural checklist, participants were allowed open-ended practice using the task trainer. Critical steps in the checklist were marked in bold lettering indicating automatic failure. Each paramedic was then individually supervised performing a minimum of 5 successful simulations. Retention was assessed using the same 16 step checklist 6 to 12 weeks following the initial training. ResultsA total of 55 paramedics completed both the initial training and reassessment during the time period studied. During the initial training phase 100% (55 of 55) of the paramedics were successful in performing all 16 steps of the wire-guided cricothyrotomy. During the retention phase, 87.3% (48 of 55) of paramedics retained the skills necessary to successfully perform the wire-guided cricothyrotomy. On the 16 step checklist, most steps were performed successfully by all the paramedics or missed by only 1 of the 55 paramedics. The step involving removal of the needle prior to advancing the airway device over the guide wire was missed by 34.5% (19 of 55) of the participants. This was not an automatic failure since most participants immediately self-corrected and completed the procedure successfully. ConclusionParamedics can be taught and can retain the skills necessary to successfully perform a wire-guided cricothyrotomy on a simulator. Future research is necessary to determine if paramedics can successfully transfer these skills to real patients.

In-Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative.

Objective To review complications of in-office endoscopic laryngeal laser procedures after implementation of standardized safety protocol. Methods A retrospective review was conducted of the first 2 years of in-office laser procedures at St Michaels Hospital after the introduction of a standardized safety protocol. The protocol included patient screening, procedure checklist with standardized reporting of processes, medications, and complications. Primary outcomes measured were complication rates of in-office laryngeal laser procedures. Secondary outcomes included hemodynamic changes, local anesthetic dose, laser settings, total laser/procedure time, and incidence of sedation. Results A total of 145 in-office KTP procedures performed on 65 patients were reviewed. In 98% of cases, the safety protocol was fully implemented. The overall complication rate was 4.8%. No major complications were encountered. Minor complications included vasovagal episodes and patient intolerance. The rate of patient intolerance resulting early termination of anticipated procedure was 13.1%. Total local anesthetic dose averaged 172.9 mg lidocaine per procedure. The mean amount of laser energy dispersed was 261.2 J, with mean total procedure time of 48.3 minutes. Sixteen percent of patients had preprocedure sedation. Vital signs were found to vary modestly. Systolic blood pressure was lower postprocedure in 13.8% and symptomatic in 4.1%. Discussion The review of our standardized safety protocol has revealed that in-office laser treatment for laryngeal pathology has extremely low complication rates with safe patient outcomes. Implications for Practice The trend of shifting procedures out of the operating room into the office/clinic setting requires new processes designed to promote patient safety.

Abdominal paracentesis: use of a standardised procedure checklist and equipment kit improves procedural quality and reduces complications.

Paracentesis is a common invasive procedure performed by junior doctors. Audit of procedure conduct at two New Zealand hospitals in 2012 revealed poor performance across a range of quality measures, including documentation of informed consent, excessive catheter dwell times and inappropriate albumin prescription. Complication rates were 12.7%, compared with published rates of around 9%. A local procedure protocol did not exist. To evaluate the effect of a standardised procedure checklist (PC) and equipment kit (EK) on procedural quality and complication rates for abdominal paracentesis. After presenting the 2012 audit results to resident doctors, we reviewed the paracentesis literature and developed a local procedure protocol (PC and EK). These tools were made readily available after an education campaign. Paracenteses performed after the intervention were studied to determine the impact on procedural quality and safety. Seventy-four paracenteses (14 diagnostic; 60 therapeutic) were performed in 10 months after the introduction of PC and EK. Significant improvements were observed with the use of PC including documentation of informed consent (97% vs 74%, P = <0.01) and aseptic technique (100% vs 62%, P = <0.01). Catheter dwell times <6 h improved (72% vs 48%, P = 0.02). Inappropriate albumin prescriptions were less frequent (21% vs 66%, P = <0.01). Complication rates decreased from 12.7% to 2.8% (P = <0.01). The PC and EK improved rates of informed consent, appropriate documentation and protocol adherence. Significantly fewer procedure-related complications occurred after introduction of these tools.

54) Enhancing Pediatric Resident Intensive Care Experience and Interdisciplinary Relationships by Increasing Procedure Based Education by PICU Nurse Practitioners.

Purpose Nurse practitioners (NPs) are valued members of the interdisciplinary PICU team. The NPs manage critically ill patients and perform procedures, although their role as educators to the residents has not been well described. The PICU resident curriculum was redesigned to incorporate more procedural teaching opportunities by the NPs. A checklist of common procedures in the PICU was distributed to each resident at the beginning of their rotation. The residents were encouraged to work with the NPs to seek out any procedure opportunities. We hypothesize that utilizing PICU NPs to …

Abstract 259: Pre-Procedure Checklist and Morning Huddle as Part of Patient Evaluation for Cardiac Catheterisation

Background: World Health Organization (WHO) Surgical Safety Checklist had a significant impact on surgical outcomes(1). In 2009, The United Kingdom National Patient Safety Agency required the use of this checklist(2). A pre procedure checklist for central venous line placements was one of the first commonly used checklists, and since then, the concept has been expanded to include venous thromboembolism prophylaxis, patient discharge, and many more(3). In 2016, Society of Cardiovascular Angiography and Interventions (SCAI) published a best practices consensus statement Update, which included a pre-procedure checklist for cardiac catheterizations(4). Objectives: The goals of the project were two-fold. First, to formalize the pre-procedure evaluation of patients referred to the cardiac catheterization laboratory, and second, to introduce a ‘Morning Huddle’ for all team members. The huddle is directed by a physician and includes a brief patient history and procedural plan to ensure everyone has a clear understanding of the procedure indication, patient specific risks, and procedural equipment needed. It would also provide an opportunity for group questions or to raise concerns. Methods: Safety Attitudes Questionnaire (SAQ) was used with permission from University of Texas Health Science Center at Houston, to assess the attitudes towards safety of the staff working at the cardiac catheterization laboratory, as well as the general cardiology fellows. Cardiology fellows were provided with pre-catheterization checklist, adapted from the SCAI best practices consensus statement Update, as well as an outline for the format of the ‘Morning Huddle’. Results: The total number of responses obtained were 23. The survey revealed that the majority of the staff felt that the physicians and nurses worked in a well-coordinated team (95.7%, 22 of 23). Almost 26% (6 of 23) of the staff interviewed reported difficulty in speaking up when a problem was perceived. Communication breakdown was not noted to be a problem by the majority interviewed, although a small percentage did disagree (26%, 6 of 23). Conclusions: Although the survey was overwhelmingly positive at baseline, room for improvement was noted. It is anticipated that the intervention will allow the staff an opportunity to speak up when a problem is perceived, and improve communication, by empowering the team during the ‘Morning Huddle’. Our overarching goal is to improve the safety climate in the catheterization laboratory.