Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8605
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
One of the most well-known tools for improving patient safety is the World Health Organization’s Surgical Safety Checklist (WHO SSC), which has been extensively evaluated. Studies have shown that implementing the WHO SSC contributes to better patient outcomes. Improved communication in surgical teams, a factor known to be associated with better patient outcomes, is another positive effect of the WHO SSC.
Within the field of endoscopy, the number of examinations continues to increase; at the same time, this diagnostic process has become more technically advanced. Therefore, knowledge about a patient’s health condition and proper monitoring of the patient’s vital functions are crucial to prevent complications. Safety checklists similar to the WHO SSC that are specific to endoscopy have been described in the literature.
Another approach to improve healthcare quality and patient safety is promoting patient participation. Person-centered care has been described as a collaborative and respectful partnership between healthcare professionals and the patient. This study describes an attempt to combine patient safety with a person-centered approach in the endoscopy field, which to our knowledge has not been done before.
Our motivation was to explore if patient safety aspects could be combined with a person-centered approach in an endoscopy checklist. We also wanted to evaluate the impact of such a checklist. Would this novel checklist contribute to improved team communication and enhanced patient safety as previous checklists have done? Would the addition of a person-centered approach contribute to increased patient participation? Would the staff use the checklist as intended? The study contributes to the current literature through an innovative approach that could be adopted by other high-volume service areas in the medical field.
The main objectives of the study were to describe the development and implementation of a novel person-centered safety checklist and to evaluate the “checklist intervention” in terms of patient safety, person-centeredness, and teamwork.
The intervention in this study was a newly developed endoscopy checklist at a university hospital’s endoscopy unit in Sweden. The checklist was developed by a multi-professional group, and the introduction consisted of half-day sessions including lectures, a team training, and group discussions.
The intervention was evaluated using two methods: structured observations and pre/post questionnaires. The questionnaires were developed by the authors and were tested for their usability and relevance. Questionnaires were collected from both patients and staff. The structured observations included endoscopy teams of physicians and nurses. Anonymized data were analyzed using, when appropriate, the Mann-Whitney U-test, Fischer’s exact test, the χ2, and the Wilcoxon’s matched-pairs signed-ranks test.
Our observations showed frequent attempts by the physicians and nurses to use the checklist, but with suboptimal compliance.
The most salient result in the study was the increase of patient identity verifications performed by physicians. At baseline, none of the physicians performed identity checks before scope insertion. At 10 mo after the intervention, the identity verifications performed by physicians were observed at 87%.
Neither the staff nor patient questionnaires had statistically significant differences. However, the staff reported an increased awareness of the importance of patient participation, which might indicate a greater emphasis on this important aspect of person-centered care (the P-value was slightly over the cut off value of P = 0.05). These results should be interpreted carefully and need to be investigated further in future studies using validated instruments or other research methods.
This new endoscopy checklist, if properly used, could be a tool for improved patient safety, with a team training and group discussions serving as a basis for behavioral changes. The combination of patient safety aspects and a person-centered approach has been carried out and implemented with immediate positive consequences for patients and staff. However, further research is needed to evaluate the effects of the checklist, especially regarding a teamwork culture and person-centeredness.
Since no suitable questionnaires were found for this context, the authors developed their own. Although this was an educative process, this method was not sufficient to draw conclusions for some of our research objectives. In future work, solid validation is necessary for such questionnaires. Qualitative methods could bring a deeper understanding of patient and staff experiences regarding patient participation and a teamwork culture. To measure patient safety, the checklist should be implemented using standardized methods at multiple sites and by using other patient outcome measures, such as complication rates or near misses.