Guidance for the implementation of a safety checklist for gastrointestinal endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

Authors: Ian M. Gralnek, Raf Bisschops, Manmeet Matharoo, Matthew Rutter, Andrew Veitch, Peter Meier, Ulrike Beilenhoff, Cesare Hassan, Mario Dinis-Ribeiro, Helmut Messmann

Introduction

Continuous quality improvement and patient safety in gastrointestinal (GI) endoscopy are overarching priorities of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). Consistently with these societal priorities, ESGE has developed and disseminated quality indicators to improve both the efficacy and safety of GI endoscopy procedures [1, 2]. Moreover, the patients we serve expect us to provide a safe, rigorous, and standardized approach to the performance of both diagnostic and therapeutic GI endoscopy procedures.

Since Haynes et al. published their landmark study in 2009 [3], reporting that a surgery safety checklist (the World Health Organization [WHO] Surgical Safety Checklist) significantly reduced postoperative surgical mortality and inpatient adverse events, there has been a growing body of evidence demonstrating the importance of surgical safety checklists in the operating theatre [4, 5]. Studies have shown that safety checklists in the operating theatre enhance a team approach, flatten hierarchies, improve team communication and nontechnical skills, and contribute to the safe delivery of patient care [4, 5]. Taken altogether, this has led to the uptake and routine use of surgery safety checklists in operating theatres around the world.

ESGE and ESGENA believe that these same principles apply to the field of GI endoscopy. This is particularly relevant given the burgeoning volume of endoscopic procedures that are increasingly interventional and technically advanced, coupled with an aging patient population with more comorbidities. Considering this evolution in endoscopic practice, patient safety must not be compromised and measures to maintain and improve safety in GI endoscopy should continually be sought [6]. Given the above, the introduction and use of GI endoscopy safety checklists has gained traction in recent years [6–10].

Despite the recognized importance of GI endoscopy safety checklists, there are limited data on their implementation or actual use in practice in GI endoscopy units around the world. Moreover, there are still no high-level data showing that endoscopy safety checklists improve patient safety in the GI endoscopy unit, including rates of mortality, adverse events, or endoscopy completion. This evidence base is difficult to obtain given the relative rarity of severe adverse events in GI endoscopy. In a recent systematic review and narrative synthesis on checklist feasibility and impact on GI endoscopy, Bitar and colleagues reported that endoscopy team communication and teamwork significantly improved with the implementation of a GI endoscopy safety checklist [10]. Although most published studies evaluating safety checklists in the GI endoscopy setting have not reported on associations between checklist implementation and clinical outcomes, it may be extrapolated that with improved team communication, medical error may be reduced and adverse events thereby prevented [10, 11].