Improving safety and quality in endoscopy patient pathways

Patient safety is a key priority as it is acknowledged that medical error is common, multifactorial and often avoidable. Gastrointestinal endoscopy is increasingly a therapeutic procedure not without risk. Current training in endoscopy focuses on technical aspects with no formal recognition of non-technical skills such as communication, leadership, decision-making and teamwork. Error analysis in other medical specialties suggests that non-technical skills are often implicated. Recognition, understanding and training in endoscopic non-technical skills may enhance team-working skills and contribute towards patient safety. The overarching aim of this thesis is to understand the breadth of errors that occur in endoscopy and to objectively evaluate non-technical skills and teamwork in endoscopy and the colorectal cancer multi-disciplinary team. Based on this, measures to mitigate error enhance teamwork and non-technical skills will be implemented and evaluated. Part A of this thesis focuses on identifying and defining problems impacting patient safety in endoscopy. The introductory chapter details the emergence of patient safety and quality within healthcare and contextualises the importance of these concepts for endoscopy. In Chapter 2 endoscopy team members’ attitudes towards patient safety in endoscopy are explored coupled with a prospective evaluation of the frequency, type and severity of patient safety incidents. Teamwork processes are examined and presented in Chapters 3 and 4 by scientifically evaluating safety checks, technical and non-technical skill by endoscopy teams conducting elective and emergency procedures respectively. Chapter 5 evaluates the extended endoscopy pathway by measuring performance in the colorectal cancer MDT by assessing teamwork, decision-making and errors across key patient groups. Educational strategies and quality improvement interventions are implemented to support patient safety beyond endoscopy. In part B of this thesis specific interventions to enhance the safety and quality issues identified in part A are presented. Chapter 6 aims to determine the feasibility and effectiveness of a novel multi-disciplinary team training intervention for bowel cancer screening teams by targeting non-technical skills, error analysis and enhanced team performance strategies. Finally in Chapter 7 an endoscopy safety checklist is proposed and implemented into clinical practice. The checklist was prospectively evaluated in detail to examine effects on safety checks, patient safety incidents, technical and non-technical skills. In summary, this thesis serves to identify clinically transferable approaches to improve patient safety within endoscopy.Open Acces