Department of Internal Medicine, La Tour Hospital and University of Geneva, Geneva, Switzerland.
Safety, Quality, Informatics and Leadership Program, Harvard Medical School, Boston, Massachusetts, United States.
Endoscopy. 2018 Mar;50(3):203-210. doi: 10.1055/s-0043-121218. Epub 2017 Dec 13.
Checklists can prevent errors and have a positive impact on patient morbidity and mortality in different surgical settings, and possibly also in gastrointestinal endoscopy. The aims of this study were to reinforce commitment in safety culture and better communication among team members in endoscopy, and to prove the feasibility of successful checklist adoption before colonoscopy.
The study involved a pre - post quality improvement intervention involving all consecutive patients undergoing a colonoscopy at a single academic endoscopy unit. The first part of the study was a retrospective audit, carried out over a 3-month period (July to September 2016). A checklist developed through a formal validation process was implemented during the intervention period (October to December 2016). Primary outcomes were changes in patient and team satisfaction after the quality improvement intervention, using validated 5-point scale questionnaires. Secondary outcomes included successful procedure completion rates and safety outcomes.
During the baseline and comparative intervention period, 1317 and 1141 colonoscopies, respectively, were performed. Overall, checklists were fully completed by nurses and physicians for 791 patients (69.3 %). Mean overall patient satisfaction was high at baseline and did not differ following the quality improvement intervention (4.66 vs. 4.63; = 0.5). Perception of team communication and teamwork was improved after checklist implementation. Comparative analyses of per-procedure and safety outcomes did not differ between the pre- and post-checklist implementation.
Adoption of an endoscopy checklist before colonoscopy is feasible, and significantly increases perception of team communication and teamwork. Additional studies are needed to assess the generalizability of these results to complex endoscopic procedures and to characterize any improvement in patient safety outcomes.
检查表可以预防错误，并对不同外科环境中的患者发病率和死亡率产生积极影响，在胃肠内镜检查中也可能如此。本研究的目的是加强内镜检查中安全文化的承诺和团队成员之间的更好沟通，并证明在结肠镜检查前成功采用检查表的可行性。
本研究涉及一项涉及单个学术内镜单位所有连续接受结肠镜检查的患者的质量改进前后干预。研究的第一部分是回顾性审核，在 3 个月期间（2016 年 7 月至 9 月）进行。通过正式验证过程制定的检查表在干预期间（2016 年 10 月至 12 月）实施。主要结局是使用经过验证的 5 分制问卷衡量质量改进干预后患者和团队满意度的变化。次要结局包括手术成功率和安全结局。
在基线和比较干预期间，分别进行了 1317 次和 1141 次结肠镜检查。总体而言，护士和医生为 791 名患者（69.3%）完整填写了检查表。基线时总体患者满意度较高，且质量改进干预后无差异（4.66 与 4.63； = 0.5）。实施检查表后，团队沟通和团队合作的感知得到改善。手术过程和安全性结局的比较分析在检查表实施前后没有差异。
在结肠镜检查前采用内镜检查表是可行的，并且显著增加了对团队沟通和团队合作的感知。需要进一步研究以评估这些结果在复杂内镜手术中的普遍性，并描述患者安全性结局的任何改善。
