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Time out: Video audit improves endoscopy safety protocol adherence
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Patient safety is a top priority during endoscopic procedures, but inconsistent use of safety check-ins, known as the Time Out Procedure, puts up barriers to that goal.
Divyesh V. Sejpal, MD, MHCDS, chief of endoscopy at the Zucker School of Medicine at Hofstra-Northwell, and colleagues wrote in Gastrointestinal Endoscopy that using remote video audit can vastly improve adherence to those safety protocols.
“This, formal evaluation of patient safety and methods to improve patient safety in the endoscopy unit has only recently begun to emerge in the endoscopy literature,” they wrote. “Compliance with the [Time Out Procedure (TOP)] has been shown to significantly prevent adverse events and improve patient outcomes, making this an important aspect of patient safety that should be explored further in the endoscopy unit.”
The TOP is a standardized patient and procedure sign-in and verification process that helps the procedure team get on the same page to reduce adverse events and improve overall patient safety.
Researchers set up video cameras with offsite monitoring in procedure rooms and reviewed procedures over the course of 2 months to assess adherence to the TOP and identify barriers to its full implementation.
In all, investigators audited 692 procedures in which TOP compliance rate was 69.6%. They found that there was a lack of leadership in carrying out the TOP, which led to confusion and, at times, skipping the process entirely. There was also inconsistent documentation of the procedure, checklist items irrelevant to endoscopy and an overall lack of focus of patient safety culture.
To address these issues, Sejpal and colleagues implemented a few actionable items selected to improve adherence to the TOP. First, was designation of a TOP leader, followed by a visual indication of the TOP and development of an endoscopy-specific safety checklist. They also designed educational sessions to help enhance patient safety.
After implementing these changes, researchers again used video auditing to review TOP compliance. They audited 12,008 procedures from January 2017 to October 2018 and found that TOP compliance improved to 95.3% (difference from baseline 25.7; 95% CI, 22.4%–29.3%). The endoscopy unit maintained the improvement throughout the post-intervention observation period.
“TOP compliance in our endoscopy unit was significantly and sustainably increased using [remote video audit] and subsequent application of actionable process changes, which could be applied to other endoscopy units,” Sejpal and colleagues wrote. “We have found [remote video audit] to be an effective tool by which to improve this quality metric, and we plan to continue to study its use in multiple other facets of our unit’s safety and efficiency.” – by Alex Young
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures prior to publication.
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