Adverse Event and Complication Management in Gastrointestinal Endoscopy

Richter, James M.; Kelsey, Peter B.; Campbell, Emily J.

doi:10.1038/ajg.2015.423

Cited by 24 publications

(19 citation statements)

References 33 publications

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“…However, in the case of serious outcomes, the reporter may not be able to expect positive feedback and may be less willing to report them. In addition, it is challenging to clearly distinguish complications from adverse events due to medical interventions, resulting in the difference in reporting standards among healthcare workers [12,18,19]. This suggests that some of the cases considered as complications may include serious adverse events that should be reported to the mandatory national-level reporting system.…”

Section: Discussionmentioning

confidence: 99%

Patient safety management systems and activities related to promoting voluntary in-hospital reporting and mandatory national-level reporting for patient safety issues: A cross-sectional study

et al. 2021

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Both voluntary in-hospital reporting and mandatory national-level reporting systems for patient safety issues need to work well to develop a patient safety learning system that is effective in preventing the recurrence of adverse events. Some of the hospital systems and activities may increase voluntary in-hospital reporting and mandatory national-level reporting. This study aimed to identify the hospital systems and activities that increase voluntary in-hospital reporting and mandatory national-level reporting for patient safety issues. An anonymous mail survey of hospitals in Japan was conducted in 2017. The hospitals were selected by stratified random sampling according to number of beds. The survey examined the annual number of reported events in the voluntary in-hospital reporting system for patient safety and experience of reporting unexpected patient deaths possibly due to medical interventions to the mandatory national-level reporting system in the last 2 years. The relationship of the answer to the questions with the patient safety management systems and activities at each hospital was analyzed. The response rate was 18.8% (603/3,215). The number of in-hospital reports per bed was positively related to identifying events by referring complaints or questions of patients or family members, using root cause analysis for analyzing reported events, and developing manuals or case studies based on reported events, and negatively related to the unification and standardization of medical devices and equipment. The experience with mandatory national-level reporting of serious adverse events was positively related to identifying problematic cases by a person in charge of patient safety management from the in-hospital reporting system of complications and accidental symptoms. Enhanced feedback for reporters may promote voluntary in-hospital reporting of minor cases with low litigation risks. Developing an in-hospital mechanism that examines all serious complications and accidental symptoms may promote mandatory national-level reporting of serious adverse events with high litigation risks.

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Section: Discussionmentioning

confidence: 99%

Patient safety management systems and activities related to promoting voluntary in-hospital reporting and mandatory national-level reporting for patient safety issues: A cross-sectional study

et al. 2021

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“…If serious, the primary endoscopist will usually remain engaged in the subsequent management, but sometimes if it is thought to be desirable, a transfer of care to a colleague or surgeon will add depth and objectivity to the team, allowing them to make difficult judgment decisions more objectively. [7] If this is done, the patient must understand who is now responsible for his/her clinical care.…”

Section: Error Management Immediate Managementmentioning

confidence: 99%

Patient safety and error management in endoscopy ATR Axon MD FRCP

Axon

2016

Journal of Digestive Endoscopy

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This paper addresses the risk of complications in patients who undergo digestive endoscopy, the reasons why they arise and the precautions that should be taken to prevent them. It also considers issues relating to potential litigation and how to minimize this risk. The advice focuses on the importance of maintaining high-quality endoscopic practice including the day-to-day running of the service. It emphasizes the importance of teamwork, the preparation of in-house protocols, patient management before, during, and after the examination, and what measures should be taken in the event that problems do arise. It is an updated and expanded version of an invited lecture given at the Asian Pacific meeting in Bali in 2014 on behalf of the World Endoscopy Organization.

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“…However, endoscopic screening has limitations which include high cost, use of an invasive procedure and potential for adverse events (e.g. perforation, hemorrhage, and severe allergic reaction to iodine) [6]. Noninvasive methods, such as bloodbased markers are therefore needed to identify individuals at highrisk for ESCC.…”

Section: Introductionmentioning

confidence: 99%