The pre- and postprocedure assessment of patients undergoing sedation for gastrointestinal endoscopy

Patient safety in an endoscopy unit: an observational retrospective analysis of reported incidents

Introduction

Patient safety is a serious public health with serious implications on morbidity, mortality, and quality of life of patients, in addition to negatively affecting the public image of healthcare institutions and professionals. It requires further investigation, especially in specialties lacking published data, such as endoscopy.

Objective

To analyze patient safety incidents reported in a gastrointestinal endoscopy unit of a tertiary hospital in southern Brazil.

Methods

This retrospective, cross-sectional study quantitatively described patient safety incidents related to endoscopic procedures. The sample consisted of reports of incidents that occurred from 2015 to 2017. The data were descriptively analysed, and the study was approved by the relevant research ethics committee.

Results

Overall, 42,863 endoscopic procedures were performed and 167 reports were submitted in the period, accounting for a prevalence of incidents of 0.38%. Most incidents did not result in unnecessary harm to patients (76.6%). The most prevalent incidents were those related to patient identification, followed by those related to pathology exams, exam reports, gastrointestinal perforations, skin lesions, falls and medication errors. The rate of adverse events (harm to patient) in patients undergoing any endoscopic procedure was 0.06%.

Conclusions

The incidence of unnecessary harm (adverse event) associated with any endoscopic procedure was relatively low in this study. However, the identification of reported incidents is crucial for evaluating and improving the quality of care provided to patients.

Automated before-procedure electronic health record screening to assess appropriateness for GI endoscopy and sedation

BACKGROUND

Endoscopists are performing greater numbers of procedures, often on patients with complex conditions, in ambulatory settings because of changing patient demographics and referral patterns. To assist with the pre-procedure assessment of such patients, we deployed an advanced electronic health record tool, the Queriable Patient Inference Dossier (QPID), to review clinical histories and generate e-mail alerts to providers, based on clinical guidelines.

OBJECTIVE

Study the feasibility of an automated pre-procedure alert system for outpatient endoscopy.

DESIGN

We retrospectively reviewed 5 physicians' use of the application and their responses to the alerts.

SETTING

A hospital-based endoscopy unit and its two satellite outpatient clinics, Boston area, Massachusetts.

PATIENTS

Adult outpatients referred for endoscopy with moderate sedation.

INTERVENTION

Pre-procedure alerts automatically sent 7 days before the procedure, highlighting any conditions/clinical history that may affect management of the patient.

MAIN OUTCOME MEASUREMENTS

Physician use of the pre-procedure alert system and its effect on patient management.

RESULTS

We studied 1682 procedures that met inclusion criteria for review by QPID and 364 alerts (1.6% of the eligible procedures). Nearly 80% of the alerts were reviewed and responded to by the physicians, and 70 total alerts resulted in a change in patient management (4.2% of eligible procedures).

LIMITATIONS

The small size of the study group and the low rate of adverse events during the study period limit our findings. We thus plan to conduct a larger follow-up study to demonstrate changes in safety and efficiency.

CONCLUSION

Use of advanced electronic health record technologies, such as QPID, may improve provider efficiency and patient outcomes in endoscopy units.