Using Performance Management to Implement a Preprocedural Checklist for Gastrointestinal Endoscopy Procedures

Abstract

Providing safe patient care is an important focus of healthcare organizations. In surgical settings, mortality rates have been shown to decrease from 1.5% to 0.8% and complication rates from 11% to 7% when institutions use the World Health Organization's Surgical Safety Checklist. In our hospital-based gastrointestinal endoscopy unit, we recognized that inconsistencies in the preprocedural readiness of patients were causing inefficiencies in scheduling. Therefore, we initiated a quality improvement project to determine whether a preprocedural checklist and positive reinforcement for the nurses in the units could improve endoscopy preparation of patients. The checklist was used to prepare patients and to facilitate nurse-to-nurse communications. We completed a 6-week pilot study (preintervention and postintervention). The results demonstrated the importance of having nurses use a checklist in hospital care units to adequately prepare patients and to accurately communicate patient readiness before gastrointestinal endoscopy procedures. Nursing leadership used positive reinforcement as a strategy to encourage the use of the preprocedural checklist. A postpilot survey of nurses involved in the study show that the preprocedural checklist enhanced care and communication between the patient care units and resulted in direct and indirect benefits for nurses and patients.

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

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

“…dule and completed during the pilot study, suggesting a 21 % total increase in endoscopy procedure completion [18].…”

“…Kherad et al concluded that almost two-thirds of staff members (59 %) thought patient safety improved following checklist implementation. Wittren et al also reported that 57 % of nurses believed the checklist contributed to safe patient care [18].…”

“…Of the seven included articles, only three collected data on safety and clinical outcomes pre-post checklist implementation (▶ Table 3) [9,10,18]. Significant improvements were noted in teamwork and team communication (4.36 ± 0.78 vs. 3.79 ± 1.0; P = 0.04) [10], with a trend towards better quality in collaboration with nurses (P = 0.07) [9].…”

“…Furthermore, additional benefits have included reduced procedural delays according to 11 nurses (79 %), improved unit efficiency, an increase in the number of patients arriving correctly prepared for their procedure [18], and an increase in identity checks performed by the physicians (from 0 % at baseline to 87 % after 10 months, P < 0.001) [9]. Wittren et al even demonstrated an additional 19 procedures added to the sche-▶…”