Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8605-8614
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8605
Person-centered endoscopy safety checklist: Development, implementation, and evaluation
Hanna Dubois, Peter T Schmidt, Johan Creutzfeldt, Mia Bergenmar
Hanna Dubois, Peter T Schmidt, Mia Bergenmar, Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
Hanna Dubois, Peter T Schmidt, Johan Creutzfeldt, Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
Peter T Schmidt, Department of Medicine, Karolinska Institutet, Stockholm 17177, Sweden
Johan Creutzfeldt, Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm 14186, Sweden
Johan Creutzfeldt, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm 17177, Sweden
Mia Bergenmar, Department of Oncology-Pathology, Karolinska Institutet, Stockholm 17176, Sweden
Author contributions: Dubois H, Schmidt PT, Creutzfeldt J and Bergenmar M contributed to the study conception and design; Dubois H contributed to the data collection; and Dubois H, Schmidt PT, Creutzfeldt J and Bergenmar M contributed to the data analyses and interpretation and the writing and editing of the article.
Institutional review board statement: The Ethical Review Board of Stockholm regarded this study as a quality improvement project not requiring ethical approval (DNR: 2015/318-31/4).
Informed consent statement: All data collected from study participants were anonymous; therefore, written consent was not obtained. By completing questionnaires, the study participants gave their informed consent. Data from observations were completely anonymized, and due to the nature of the observations, informed consent was not possible to obtain. However, an ethical analysis based on the Declaration of Helsinki was undertaken by the authors.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Anonymous data files will be shared upon request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hanna Dubois, RN, MSN, Center for Digestive Diseases, Karolinska University Hospital, Huddinge, K51, Hälsovägen 13, Stockholm 14186, Sweden. hanna.dubois@sll.se
Telephone: +46-858586992 Fax: +46-858582565
Received: August 30, 2017
Peer-review started: August 31, 2017
First decision: September 13, 2017
Revised: September 27, 2017
Accepted: October 18, 2017
Article in press: October 18, 2017
Published online: December 28, 2017
Processing time: 119 Days and 5.8 Hours
Abstract
AIM

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

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Checklist; Communication; Endoscopy; Observation; Patient-centered care; Person-centered care; Patient safety; Teamwork

Core tip: With increasing indications and more technically advanced gastrointestinal endoscopy, finding strategies to prevent adverse events is important. Standardized methods, such as checklists and promoting patient involvement, are strategies for augmented patient safety. This paper describes the development of a novel endoscopy checklist that combined patient safety and a person-centeredness approach. After the introduction of the checklist, physicians’ verifications of patients’ identities before their examinations increased significantly. However, compliance to the checklist was suboptimal, possibly due to insufficient training. With more team training for all staff members, the checklist could be a tool for increased person-centeredness and safety.