• GI endoscopy
• patient safety
• safety checklist
• team time out

• "This work was supported by a grant of Ministry of Research and Innovation-project number ID P_34_498, within MFE 2014-2020-POC" Ministerul Cercetării și Inovării

• clinical skills
• consent
• diagnostic tests
• endoscopy
• informed consent
• nursing care
• patients
• professional
• screening

• Colonoscopy/methods
• Humans

• endoscopy

Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3–1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.

• adverse event
• colonoscopy
• complications
• haemorrhage
• polypectomy

• Gastrointestinal endoscopy
• Medical errors
• Patient safety
• Risk management

• Cross-Sectional Studies
• Endoscopy
• Humans
• Patient Safety
• Quality of Life
• Retrospective Studies
• Risk Management

• endoscopy

• endoscopy
• quality control
• upper gastrointestinal tract

• Moderate sedation
• Obesity
• Safety of endoscopy

• colonoscopy technique

• endoscopy

• Endoscopy
• Evidence-based practice
• Non-variceal bleeding
• Upper gastrointestinal bleeding
• Variceal bleeding

• endoscopy

National Health Service England published the National Safety Standards for Invasive Procedures (NatSSIP) in 2015. They mandated that individual trusts produce Local Safety Standards for Invasive Procedures (LocSSIPs), a set of safety standards drawn from the NatSSIP that apply to a particular clinical situation in a given department, for all invasive procedures.

The project goal was to design and implement the LocSSIP within the endoscopy department. A draft LocSSIP was produced, and a pilot study conducted to gain initial feedback on its use. Version 1 of the checklist was produced and after approval, rolled out for use within the endoscopy department at ‘time out’ and ‘sign out’. A scoring system was developed that allowed the quality of the performance of LocSSIPs to be assessed and recorded as a ‘compliance score’.

After 2 months, an independent observer spent a week assessing use of the checklist, recording completion and a compliance score. Analysis of this data led to a number of changes in performing the checklist, wider multidisciplinary team education and integration of the checklist into existing documentation, before reassessing at 12 months.

In 2016, ‘time out’ checks were completed in 100% of cases, but full completion was only observed in 68%. ‘Sign out’ checks were completed in 91% of cases, with full completion in 71%. In 2017, ‘time out’ checks were completed in 100% of cases, with full completion in 85%. ‘Sign out’ checks were completed in 100% of cases, with full completion in 91%.

The composite score for compliance in 2016 was 57% increasing to 90% in 2017.

In conclusion, stronger departmental leadership, broadening education and integration of the checklist into routine documentation to reduce duplication led to significant improvements in compliance with use of the checklist. Ongoing education and assessment is imperative to ensure that compliance is maintained to ensure patient safety.

• checklists
• quality improvement
• safety culture

• clinical competence
• continuing education
• gastrointestinal endoscopy
• importance-performance analysis
• patient simulation Korea

To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a “checklist intervention”.

The checklist, based on previously published safety checklists, was developed and locally adapted, taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team’s performance were conducted before and after the introduction of the checklist. In addition, questionnaires focusing on patient participation, collaboration climate, and patient safety issues were collected from patients and staff.

A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted (from 0% at baseline to 87% after 10 mo, P < 0.001), and remained high among nurses (93% at baseline vs 96% after 10 mo, P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist, but compliance was suboptimal: All items in the observed nurse-led “summaries” were included in 56% of these interactions, and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff, items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist, but this did not result in statistical significance (P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist; hence, no statistical difference was noted.

The intervention led to increased patient identity verification by physicians - a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.

• Checklist
• Communication
• Endoscopy
• Observation
• Patient-centered care
• Person-centered care
• Patient safety
• Teamwork

• Adult
• Checklist
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Endoscopy, Gastrointestinal/standards
• Female
• Gastroenterologists/organization & administration
• Gastroenterologists/psychology
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/therapy
• Health Plan Implementation
• Humans
• Male
• Patient Care Team/organization & administration
• Patient Participation
• Patient Safety
• Physician-Patient Relations
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Quality Improvement
• Surveys and Questionnaires
• Sweden
• Work Performance
• Young Adult

• OGD
• early upper gastro-intestinal cancer
• key performance indicators
• quality

• Barrett Esophagus/diagnostic imaging
• Barrett Esophagus/pathology
• Celiac Disease/diagnostic imaging
• Celiac Disease/pathology
• Checklist
• Clinical Competence
• Endoscopy, Digestive System/methods
• Endoscopy, Digestive System/standards
• Gastrointestinal Diseases/diagnostic imaging
• Gastrointestinal Diseases/pathology
• Gastrointestinal Neoplasms/diagnostic imaging
• Gastrointestinal Neoplasms/pathology
• Humans
• Informed Consent/standards
• Patient Safety
• Patient Selection
• Precancerous Conditions/diagnostic imaging
• Precancerous Conditions/pathology

• ENDOSCOPY

• ENDOSCOPY

• Colonoscopy
• Endoscopy safety
• Moderate sedation
• Procedural sedation
• Propofol
• Quality

The number of potentially preventable medical errors that occur has been steadily increasing. These are a significant cause of patient morbidity, can lead to life-threatening complications and may result in a significant financial burden on health care. Effective communication and team working reduce errors and serious incidents. In particular the implementation of the World Health Organisation (WHO) Safe Surgery Checklist has been shown to reduce in-hospital mortality, postoperative complications and the incidence of surgical site infection. However an increasing number of complex medical procedures and interventions are being performed outside of the theatre environment. The lessons learnt from the surgical setting are relevant to other procedures performed in other areas. For the echocardiographer, transoesophageal echocardiography (TOE) is one such procedure in which there is the potential for medical errors that may result in patient harm. This risk is increased if patient sedation is being administered. The British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists have developed a procedure specific checklist to facilitate the use of checklists into routine practice. In this article we discuss the evolution of the WHO safety checklist and explore its relevance to TOE.

• World Health Organsiation
• checklist
• safety

Gastrointestinal endoscopy is a widely used diagnostic and therapeutic procedure both within the United Kingdom and worldwide. With an increasingly older population the potential for complications is increased. The Wolfson Unit for Endoscopy at St. Mark's Hospital in London is a tertiary referral centre, which conducts over 14,000 endoscopic procedures annually. However, despite this high throughput, our baseline observations were that the procedure for safety checks was highly variable.

Over a seven-day period we conducted a questionnaire-based survey to all staff members involved with endoscopy within our unit. We found that there was little consensus between team members, both in terms of essential safety checks and designating responsibility for the checks. A panel of experts was convened in order to devise a safety checklist and a strategy for increasing compliance with the checklist among all staff members. Using a combination of electronic and physical reminders and incentives, we found that there was a significant increase in completed checklist (53% to 66%, p = 0.021) and decrease in the number of checklists left blank post intervention (10% to 2%, p=0.03). We believe that post implementation validation of safety checklists is an important method to ensure their proper use.