Abstract
Background and study aim Checklists prevent errors and have a positive impact on patient morbidity and mortality
in surgical settings. Despite increasing use of checklists in gastrointestinal endoscopy
units across many countries, a summary of cumulated experience is lacking. The aim
of this study was to identify and evaluate the feasibility of successful checklist
implementation in gastrointestinal endoscopy units and summarise the evidence of its
impact on the commitment in safety culture.
Methods A comprehensive literature search was performed identifying the use of a checklist
or time-out in endoscopy units from 1978 to January 2020 using OVID MEDLINE, EMBASE,
and ISI Web of Knowledge databases, with search terms related to checklist and endoscopy.
We summarised overall adherence to checklists from included studies through a narrative
synthesis, characterizing barriers and facilitators according to nurse and physician
perspectives, while also summarizing safety endpoints.
Results The seven studies selected from 673 screened citations were highly heterogeneous
in terms of methodology, context, and outcomes. Across five of these, checklist adherence
rates post-intervention varied for both nurses (84 % to 96 %) and physicians (66 %
to 95 %). Various facilitators (education, continued reassessment) and barriers (lack
of safety culture, checklist completion time) were identified. Most studies did not
report associations between checklist implementation and clinical outcomes, except
for better team communication.
Conclusion Implementation of a gastrointestinal endoscopy checklist is feasible, with an understanding
of relevant barriers and facilitators. Apart from a significant increase in the perception
of team communication, evidence for a measurable impact attributable to gastrointestinal
checklist implementation on endoscopic processes and safety outcomes is limited and
warrants further study.
