Improving Quality and Safety in Gastrointestinal Endoscopy

Project summary

Background

Gastrointestinal Endoscopy is a rapidly expanding practice given the vast diagnostic and therapeutic potential. This is particularly relevant in the context of bowel cancer screening and the inevitable consequent expansion in endoscopy. There is a drive towards improving quality assurance in endoscopy particularly in the context of screening a healthy population. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report ‘Scoping our Practice’ (Cullinane M, 2004) demonstrated an overall mortality of 3% following therapeutic endoscopic procedures.

Research within high-risk industries such as the airline industry has illustrated that errors with significant impact on safety often relate to non-technical skills rather than technical ability. (Flin R, 2008) This concept has been translated into surgery (Yule S, 2012) and anaesthesia (Flin R, 2010) recently and is relevant to endoscopic practice. By focusing on the identification of key non-technical skills and raising awareness of these skills amongst endoscopists, we hope to improve patient safety by reducing errors.

Communication and decision making between endoscopy and colorectal cancer MDTs remain complex, dependent on inputs from multiple specialities and hence error prone. Analysing this part of the patient pathway is an important aspect of safe holistic patient care.

Conducting critical incident and near miss analyses of the core and wider teams in endoscopy will give a clearer picture of patient safety incidents. This will establish where the weaknesses lie and develop strategies to prevent these errors form occurring.

An endoscopy safety checklist to standardise safety checks and engender team inclusion has been implemented at St. Mark’s Hospital and is currently being validated.

Endoscopy team optimisation will help define more accurately the roles, responsibilities and interactions of clinical and non-clinical team members, with a view to increased efficiency in the flow of endoscopy from the patients’ perspective.

Aims

This work aims to develop the concept of patient safety in the context of endoscopy through several themes: 

Teams

• Evaluating roles and responsibilities of key team members
• Analysing non-technical skills, safety behaviours and team function using an endoscopy behavioural rating scale

Patient safety

• Analysing patient safety incidents and educating teams on preventable errors
• Devising a safety checklist specific to endoscopy

Education and training

• Provide high quality, standardised individual and team training
• Develop ENTS team training using simulation

Outputs

Improving Quality and Safety in Gastrointestinal Endoscopy (PDF)

Resources

Endoscopy Safety Checklist (PDF)