Bitar Véronique, Martel Myriam, Restellini Sophie, Barkun Alan, Kherad Omar
Division of Internal Medicine, Université de Montréal, Montreal, Canada.
Division of Gastroenterology, McGill University, Montreal, Canada.
Endosc Int Open. 2021 Mar;9(3):E453-E460. doi: 10.1055/a-1336-3464. Epub 2021 Feb 19.
Checklists prevent errors and have a positive impact on patient morbidity and mortality in surgical settings. Despite increasing use of checklists in gastrointestinal endoscopy units across many countries, a summary of cumulated experience is lacking. The aim of this study was to identify and evaluate the feasibility of successful checklist implementation in gastrointestinal endoscopy units and summarise the evidence of its impact on the commitment in safety culture. A comprehensive literature search was performed identifying the use of a checklist or time-out in endoscopy units from 1978 to January 2020 using OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases, with search terms related to checklist and endoscopy. We summarised overall adherence to checklists from included studies through a narrative synthesis, characterizing barriers and facilitators according to nurse and physician perspectives, while also summarizing safety endpoints. The seven studies selected from 673 screened citations were highly heterogeneous in terms of methodology, context, and outcomes. Across five of these, checklist adherence rates post-intervention varied for both nurses (84 % to 96 %) and physicians (66 % to 95 %). Various facilitators (education, continued reassessment) and barriers (lack of safety culture, checklist completion time) were identified. Most studies did not report associations between checklist implementation and clinical outcomes, except for better team communication. Implementation of a gastrointestinal endoscopy checklist is feasible, with an understanding of relevant barriers and facilitators. Apart from a significant increase in the perception of team communication, evidence for a measurable impact attributable to gastrointestinal checklist implementation on endoscopic processes and safety outcomes is limited and warrants further study.
检查表可预防差错，并对外科手术环境中的患者发病率和死亡率产生积极影响。尽管许多国家的胃肠内镜检查科室越来越多地使用检查表，但缺乏累积经验的总结。本研究的目的是确定并评估在胃肠内镜检查科室成功实施检查表的可行性，并总结其对安全文化承诺影响的证据。 使用OVID MEDLINE、EMBASE和ISI Web of Knowledge数据库，对1978年至2020年1月期间内镜检查科室使用检查表或暂停程序的情况进行了全面的文献检索，检索词与检查表和内镜检查相关。我们通过叙述性综合总结了纳入研究中对检查表的总体依从性，从护士和医生的角度描述障碍和促进因素，同时也总结了安全终点。 从673篇筛选出的文献中选出的7项研究在方法、背景和结果方面高度异质。在其中5项研究中，干预后护士（84%至96%）和医生（66%至95%）的检查表依从率各不相同。确定了各种促进因素（教育、持续重新评估）和障碍（缺乏安全文化、检查表完成时间）。除了团队沟通改善外，大多数研究没有报告检查表实施与临床结果之间的关联。 胃肠内镜检查表的实施是可行的，需要了解相关的障碍和促进因素。除了团队沟通意识显著提高外，胃肠检查表实施对内镜检查过程和安全结果产生可衡量影响的证据有限，值得进一步研究。
