Introduction
Safety in endoscopy is of paramount importance with increasingly therapeutic and complex procedures. Despite safety initiatives, incidents still occur. In order to learn from these, we need to be able to better detect issues. The patient voice has been crucial in understanding healthcare from a different perspective. Specifically, patient reporting has been able to detect safety-related issues, which may not have been identified through other means [1, 2]. This is an area not previously explored in endoscopy.
Aims & Methods
Our aims were to develop a novel tool for patient reporting of safety incidents in endoscopy (PRISE), co-designed with patients. Secondary aims were to identify safety incidents, factors and perceptions.
This study was split into two phases. Phase one involved a literature review of articles related to patient reported incidents, followed by patient focus groups to identify key topic areas to address and survey design ideas. These findings informed development of the PRISE survey tool. A patient panel was created and, through regular refinement meetings with the research team, question items were created.
Phase two was a prospective pilot of the PRISE tool in a single academic centre. The survey was disseminated over an 8 month period through physical and electronic media. Patients were asked to complete this within 2 weeks of their procedure. Outcome measures included the percentage of positive responses (PPR) across question item domains, safety perception scores and number of safety incidents detected. Descriptive and comparative analyses were performed.
Results
In phase one, over 1600 articles were identified from search criteria. Following title, abstract and full text screens, 17 full text articles were included in the literature review. A total of 24 incident topic areas were identified. Three focus groups were conducted with 22 participants. Outcomes were focussed around five themes: question style, content, question items, timing, and dissemination. The PRISE co-design process was conducted over ten sessions. The final survey consists of the following sections: demographics, safety incidents and factors – 24 items, grouped into domains (pre-procedure, post-procedure, unit and staff), safety concerns – a qualitative section, and safety perceptions – a quantitative score.
In phase two, 596 patients responded to the survey. Perceptions of safety were overwhelmingly high (mean rating 9.7/10). The PPR for all domains was > 90%, with the staff domain (items on staff characteristics) rated significantly higher than all others (96.7% PPR; p < 0.001). Four clear PSIs were identified - three related to equipment failure and one regarding wrong bowel preparation. Six patients (1.0%) declared safety concerns. Two patients felt they suffered from a mistake. The five highest negatively rated question items were related to information handover, management of patient concerns during procedure, physical space in the unit, equipment faults during procedure, and unnecessary delays in care respectively. Thematic analysis of comments identified negative themes related to bowel preparation, care process issues, communication, constraints on service, environment, equipment, procedures, and staff.
Conclusion
A patient co-designed pilot prospective survey identified high perceived safety in the endoscopy unit. Staff characteristics were rated highly. Safety incidents were detected as well as areas to focus on for safety improvement.
References
1. Armitage, G., et al., Patient-reported safety incidents as a new source of patient safety data: an exploratory comparative study in an acute hospital in England. Journal of Health Services Research & Policy, 2017. 23(1): p. 36-43.
2. Weingart, S.N., et al., What can hospitalized patients tell us about adverse events? Learning from patient-reported incidents. Journal of general internal medicine, 2005. 20(9): p. 830-6.
Disclosure
HA is Chief Scientific Officer of Pre-emptive Medicine and Health Security at Flagship Pioneering. AD is Executive Chair of Pre-emptive Medicine and Health Security at Flagship Pioneering
