Improving patient safety in the endoscopy unit: utilization of remote video auditing to improve time-out compliance

Raphael, Kara L.; Cerrone, Sara; Sceppa, Edward A.; Schneider, Patricia; Laumenede, Tara; Lynch, Ann M.; Sejpal, Divyesh V.

doi:10.1016/j.gie.2019.04.237

Cited by 9 publications

(18 citation statements)

References 19 publications

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“…After review, seven articles were included in our study (▶ Fig. 1 and ▶ Table 1) [9,10,[14][15][16][17][18].…”

Section: Resultsmentioning

confidence: 99%

“…Most focused on educational lectures to frontline staff about patient safety culture and checklist utility. Notably, Raphael et al [17] tried to improve rates of compliance with the checklist by using remote video auditing (RVA). This intervention consists of installation of cameras in every endoscopic room to monitor compliance and application of the time-out in order to collect data but also to encourage the team to complete the checklist appropriately.…”

Section: Adherence To the Checklistmentioning

confidence: 99%

“…Many barriers and facilitators driving adherence to the checklist were identified (▶ Table 2). Raphael et al identified four barriers limiting compliance to the endoscopic checklist: lack of leadership, inconsistent documentation of the time-out process, irrelevant safety checklist items, and lack of a patient safety culture [17]. Kherad et al in turn identified as barriers the time required to complete the checklist, loss of physician autonomy, and fear of accentuating patient anxiety [10].…”

Section: Adherence To the Checklistmentioning

confidence: 99%

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

et al. 2021

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Background and study aim 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. Methods 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. Results 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. Conclusion 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.

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“…After review, seven articles were included in our study (▶ Fig. 1 and ▶ Table 1) [9,10,[14][15][16][17][18].…”

Section: Resultsmentioning

confidence: 99%

Section: Adherence To the Checklistmentioning

confidence: 99%

Section: Adherence To the Checklistmentioning

confidence: 99%

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

et al. 2021

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“…UGI endoscopy remains an aerosol-generating procedure, due to the potential for retching, coughing and open airway suction use. It is therefore one of the main areas where new processes and protocol are needed [ 97 ]. In the midst of the pandemic, forgotten or new pathways and protocols have been brushed up and discussions about employing new, distance-retaining, non-aerosol generating procedures are much alive.…”

Section: Endoscopy Services In the Covid-19 Era: Call For Innovatimentioning

confidence: 99%

Frontiers of Robotic Gastroscopy: A Comprehensive Review of Robotic Gastroscopes and Technologies

Marlicz

Ren

Robertson

et al. 2020

Cancers

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Upper gastrointestinal (UGI) tract pathology is common worldwide. With recent advancements in robotics, innovative diagnostic and treatment devices have been developed and several translational attempts made. This review paper aims to provide a highly pictorial critical review of robotic gastroscopes, so that clinicians and researchers can obtain a swift and comprehensive overview of key technologies and challenges. Therefore, the paper presents robotic gastroscopes, either commercial or at a progressed technology readiness level. Among them, we show tethered and wireless gastroscopes, as well as devices aimed for UGI surgery. The technological features of these instruments, as well as their clinical adoption and performance, are described and compared. Although the existing endoscopic devices have thus far provided substantial improvements in the effectiveness of diagnosis and treatment, there are certain aspects that represent unwavering predicaments of the current gastroenterology practice. A detailed list includes difficulties and risks, such as transmission of communicable diseases (e.g., COVID-19) due to the doctor–patient proximity, unchanged learning curves, variable detection rates, procedure-related adverse events, endoscopists’ and nurses’ burnouts, limited human and/or material resources, and patients’ preferences to choose non-invasive options that further interfere with the successful implementation and adoption of routine screening. The combination of robotics and artificial intelligence, as well as remote telehealth endoscopy services, are also discussed, as viable solutions to improve existing platforms for diagnosis and treatment are emerging.

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“…In our center, we have installed remote video auditing (RVA) cameras in the endoscope reprocessing room, which coincided with the opening of a new endoscopy unit. RVA has long been shown to improve safety and compliance in commercial industries such as meatpacking and fast food [15][16][17][18][19], and has recently been highly successful in improving compliance with surgical safety measures in the operating room [20,21], procedure verification proceedings in the endoscopy unit [22], as well as in pilot evaluations of compliance with endoscope cleaning in a community setting within our hospital system [23] and in a center outside of our system [24]. However, it is not known whether RVA in a high-volume tertiary care center is feasible.…”

Section: Introductionmentioning

confidence: 99%

Remote video auditing in the endoscopy unit for evaluation of duodenoscope reprocessing in a tertiary care center

et al. 2020

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Background A significant proportion of duodenoscope-transmitted infections have resulted from errors related to reprocessing. Remote video auditing (RVA) is a tool that can monitor reprocessing compliance but it has not been previously evaluated in a tertiary care setting. The aims of this study were to evaluate: 1) RVA feasibility in a tertiary care setting (defined as the ability to audit every step of duodenoscope reprocessing without delaying the next procedure due to unavailability of duodenoscopes); and 2) the use of RVA as a compliance monitoring tool. Methods This was a prospective study at a tertiary care center. A video camera with offsite monitoring was installed in March 2018. Auditors delivered a compliance score after each procedure. The duodenoscope was not used until it passed the audit. Feasibility and compliance data were collected from April 2018 to August 2019 after a 1-month run-in phase. Both per-step compliance and overall 100 % compliance rates were measured. Results Of 743 duodenoscope reprocessing procedures, 32 666 individual steps were audited and 99.9 % of the steps were fully viewable. The mean time per audit was 38.3 minutes, the mean duodenoscope turnover time was 76.1 minutes, and there were no delays to the next procedure due to unavailability of duodenoscopes. The per-step compliance rate was 99.5 % but the overall 100 % compliance rate was 90.3 %. Conclusions The use of RVA in duodenoscope reprocessing was feasible and promoted sustained high-level compliance in a tertiary care center.

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Improving patient safety in the endoscopy unit: utilization of remote video auditing to improve time-out compliance

Cited by 9 publications

References 19 publications

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

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

Frontiers of Robotic Gastroscopy: A Comprehensive Review of Robotic Gastroscopes and Technologies

Remote video auditing in the endoscopy unit for evaluation of duodenoscope reprocessing in a tertiary care center

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