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Multidisciplinary infrastructure validated for tracking endoscopic adverse events
Researchers have validated a multidisciplinary infrastructure process designed to capture endoscopic adverse events in a high-volume endoscopy center.
“Capturing and tracking adverse events associated with endoscopic procedures is an essential element in understanding the safety and quality of care that is provided by gastroenterologists and requires an infrastructure that enlists the help of other providers and the patients,” Dawn L. Francis, MD, from the division of gastroenterology and hepatology at the Mayo Clinic in Jacksonville, Fla., told Healio Gastroenterology.
Dawn L. Francis
Aiming to validate an existing multidisciplinary infrastructure (MDI) for identifying the number, type and severity of endoscopy-related adverse events, Francis and colleagues performed a prospective study comparing MDI with direct patient telephone contact.
The MDI process entails:
- endoscopy nurse reporting of adverse events during or immediately after the procedure using reporting cards or a voicemail event line;
- electronic reporting of adverse events via an institutional website link that can be used by any health care worker;
- weekly electronic reminders to report adverse events;
- an endoscopic complication card provided to all patients at the time of their procedure to be returned if they experience an adverse event; and
- an automated reporting system that identifies patients admitted to the hospital within a week of the procedure.
The patient contact procedure involved attempting to inquire about adverse events by phone 14 to 90 days after patients underwent an endoscopic procedure between July and December 2011. The investigators compared the proportion, type and severity of adverse events identified by each methodology, both employed simultaneously during the study period.
Overall, 11,710 endoscopic procedures were performed on 9,683 patients. At least one call was made to 20.6% of all patients, and 84.5% of those called were contacted, which resulted in 28 true adverse events identified (78.5% mild, 17.8% moderate, 3.5% severe). Compared with phone query, the MDI process identified 93 adverse events, 46.2% of which were mild (P = .003), 36.5% moderate (P = .07), 12.9% severe and 4.3% fatal. Intention-to-treat analysis showed MDI had a higher adverse event capture rate (P = .0001), whereas per-protocol analysis showed no significant difference between methodologies.
“This study showed a method, besides direct patient contact, that can track adverse events effectively, in a way that many practices can adopt,” the researchers wrote. “We believe our practice has benefited from this infrastructure, not only because of our ability to track adverse events and use trends to improve our practice, but also because it has promoted a distinct cultural shift toward a focus on quality and safety.
“We acknowledge that this infrastructure does use some resources and is not no-cost,” they added. “However, many experts agree that quality improvement and reporting processes require dedicated resources that should be considered part of the cost of practice.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.