Creating A Generalizable Checklist For The Construction Of A Coronary Anastomosis Using A Delphi Approach

A checklist for a complex technical skill in cardiothoracic surgery can be produced using a Delphi method and engaging clearly defined experts from across the US. However, there is considerable variability among experts. Over 70% of the items experts independently believed to be mandatory for the performance of a technically proficient coronary anastomosis were unable to be accepted by the group into the final consensus list of items. In fact, when queried about an item they had themselves initially suggested, in the context of all the other items submitted by the other experts, many faculty were unwilling to identify the item as mandatory. These findings severely question the ability of any small local group of surgeons from creating a checklist that includes all the relevant items for a comprehensive checklist. Locally developed checklists will contain significant gaps (missed items) or non-mandatory items when examined by a more geographically diverse population of surgeons. These findings therefore threaten the generalizability of any locally produced checklist if used outside the location of origin.