Checklist feasibility and impact in gastrointestinal endoscopy: a systematic review and narrative synthesis

Investigation of the actual implementation of "post-sedation discharge briteria" and "time-out" immediately before procedure in endoscopy: A nationwide survey study in Japan

OBJECTIVES

Post-sedation discharge criteria for outpatient endoscopy and time-out procedures immediately before endoscopic examinations are important for ensuring patient safety. This study used a web-based questionnaire to survey the implementation status and current situation of these practices in Japan in 2024.

METHODS

A self-administered questionnaire was conducted from December 2023 to January 2024 using Google Forms. Participants were primarily from facilities involved in endoscopy study groups and readers of an endoscopy-specific e-newsletter. Additionally, medical staff from endoscopic centers across Japan were invited to participate in collaboration with the Japan Gastroenterological Endoscopy Technicians Society.

RESULTS

A total of 1,495 valid responses (medical staff: 1197 [80%]; doctors: 298) were collected from 1168 facilities, after excluding duplicate responses. Among the participating facilities, 58% were general hospitals, 21% were clinics or health check-up centers, and 9% were university hospitals or national cancer centers. Post-sedation discharge criteria were implemented in 58% of facilities for esophagogastroduodenoscopy and 56% for colonoscopy, with the post-sedation recovery score used as the criterion in about half of these cases. Time-out procedures were implemented in 57% of the facilities for both esophagogastroduodenoscopy and colonoscopy. Items confirmed during time-out in more than half of the facilities included: patient's name, details of antithrombotic drugs, content of examination, drug allergies, underlying disease, date of birth, consent form, age, procedure start time, and patient's identification number.

CONCLUSION

The implementation rate of post-sedation discharge criteria and time-out procedures was found to be close to 60%, reflecting the real-world situation in Japan in 2024.

[Rethinking Endoscopy: Strategies from Aviation and their Transfer to Medicine - An Overview]

The demands on modern endoscopy have grown rapidly in various areas in recent decades. These include challenges for the endoscopy team due to more demanding interventional procedures, but also the rapidly changing conditions that today's working reality entails. In order to continue to meet the necessary safety and quality standards, it can help to look at similarly complex areas such as civil aviation to find inspiration for effective concepts in endoscopy.Crew Resource Management (CRM) and Threat and Error Management (TEM) are important concepts from civil aviation that currently make aviation the safest mode of transportation in the world. Elements such as communication, teamwork, situational awareness, decision-making and an open error culture can also be used in medicine. Some of these have already been successfully transferred to acute medical areas by using CRM-based training and general or specific checklists. In order to also benefit as much as possible from the findings in endoscopy, workshops tailored to the individual requirements of the respective endoscopy unit are available, in which measures can be developed in collaboration with professional CRM trainers. Examples of this would be a standardized communication guideline for endoscopic procedures, a pre-interventional safety checklist or a TEM-based dialogical team time-out. After implementation, regular evaluation and further development of the measures are essential for long-term success.Elements transferred from civil aviation have the potential to promote communication, situation-aware teamwork, structured decision-making and an open error culture in endoscopic teams and thus contribute to safe and high-quality interventions.

Construction and Application Research of a Perioperative Inspection Checklist for Acute Upper Gastrointestinal Bleeding

PURPOSE

To enhance patient safety and improve communication and response times during the perioperative management of patients with acute upper gastrointestinal bleeding, a checklist was developed, tested for psychometric properties, and implemented in clinical practice.

DESIGN

This is a methodological study.

METHODS

A perioperative checklist for acute upper gastrointestinal bleeding was developed using a literature review and the Delphi method. The psychometric properties of the checklist were assessed through reliability and validity testing, including Cronbach's α coefficient, split-half reliability, content validity, and construct validity. A pre-and-post intervention study was conducted to evaluate the checklist's practical impact on clinical outcomes. Data were collected on safety indicators, efficiency metrics (including response times), and satisfaction levels.

FINDINGS

The final checklist comprises 19 items across 3 domains: preoperative, intraoperative, and postoperative management. The Cronbach's α coefficient was 0.775, indicating good internal consistency. Split-half reliability was 0.701. The scale-content validity index/average for the 3 domains was 0.987, 0.971, and 0.904, respectively, while the item-content validity index ranged from 0.857 to 1.000, demonstrating excellent content validity. Factor loadings for each item exceeded 0.5, and 6 latent factors explained 83.874% of the total variance, confirming the checklist's strong factor structure. In the clinical application, 210 cases were analyzed-101 before and 105 after checklist implementation. The response time for emergency endoscopy improved significantly (t = -2.556, P < 0.05). Additionally, satisfaction with team collaboration showed significant improvement (χ2 = 8.56, P < 0.05), highlighting the checklist's effectiveness in enhancing clinical outcomes and coordination among the health care team.

CONCLUSIONS

The perioperative checklist for acute upper gastrointestinal bleeding demonstrates strong reliability, validity, and practical utility. Its application improves response times, patient safety, and teamwork, making it an effective tool for perioperative management in patients with acute upper gastrointestinal bleeding.

Implementation of a Customized Safety Checklist in Gastrointestinal Endoscopy and the Importance of Team Time Out-A Dual-Center Pilot Study

Background and Objectives: Checking and correctly preparing the patient for endoscopic procedures is a mandatory step for the safety and quality of the interventions. The aim of this paper is to emphasize the importance and necessity of a "team time out" as well as the implementation of a customized "checklist" before the actual procedure. Material and Methods: We developed and implemented a checklist for the safe conduct of endoscopies and for the entire team to thoroughly know about the patient's medical history. The subjects of this study were 15 physicians and 8 endoscopy nurses who performed overall 572 consecutive GI endoscopic procedures during the study period. Results: This is a prospective pilot study performed in the endoscopy unit of two tertiary referral medical centers. We customized a safety checklist that includes the steps to be followed before, during and after the examination. It brings together the whole team participating in the procedure in order to check the key points during the following three vital phases: before the patient falls asleep, before the endoscope is inserted and before the team leaves the examination room. The perception of team communication and teamwork was improved after the introduction of the checklist. The checklist completion rates, identity verification rates of patients by the endoscopist, adequate histological labeling management and explicit recording of follow-up recommendations are some of the parameters that improved post-intervention. Conclusions: Using a checklist and adapting it to local conditions is a high-level recommendation of the Romanian Ministry of Health. In a medical world where safety and quality are essential, a checklist could prevent medical errors, and team time out can ensure high-quality endoscopy, enhance teamwork and offer patients confidence in the medical team.

Using checklists to improve care in the nonoperating room environment

PURPOSE OF REVIEW

As the number and complexity of cases performed in the nonoperating room environment continue to increase to a higher share of all anesthetic procedures, checklists are needed to ensure staff and patient safety.

RECENT FINDINGS

Providing anesthesia care in the nonoperating room environment poses specific challenges. Closed claims data base analysis shows a higher morbidity and mortality in this setting. This is driven by the location-related challenges, and critical patients undergoing minimally invasive procedures, as well as a higher percentage of emergency and after-hours procedures. Although adequate case preparation and maintaining the same standard of care as in the main operating room, establishing protocols and checklists for procedures in nonoperating room locations has emerged as a sound strategy in improving care and safety.

SUMMARY

Anesthesia in the nonoperating room environment is becoming an increasing share of total anesthesia cases. Establishing protocols and implementing site-specific checklists is emerging as a strategy in improving care in the environment of nonoperating room.

VIDEO ABSTRACT

http://links.lww.com/COAN/A89 .

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

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.