A NATIONAL SURVEY OF SAFETY ACROSS UK ENDOSCOPY SERVICES

IntroductionThe ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy has highlighted the need to improve our understanding of factors related to safety across UK endoscopy. This study assesses aspects of safety that were included in the Joint Advisory Group on Gastrointestinal endoscopy (JAG) biennial census of services.MethodsAn expert panel devised questions across 7 themes that complemented JAG safety domains. These were incorporated into the census of UK JAG-registered services in April 2019. Census results were collated and analysed. Categorical data was analysed through Chi square, Fisher’s Exact, Kruskal Wallis and Friedman’s tests. Free text responses were analysed thematically.ResultsThe response rate was 68.4%. Across March 2019, a total of 1535 patient safety incidents (PSIs) were reported (per service mean 4.80, SD 11.87). There was a significant difference in reporting dependent on incident type (p <0.001). Technical and training incidents were least likely to be reported (see figure 1). There was no effect of region, service type or JAG accreditation status on reporting behaviour. Anaesthetic-supported (AS) lists were unavailable to 27% of services. This varied amongst service type (p < 0.001) but not region (p = 0.13). There was a significant difference between the current and desired number of AS lists (p < 0.001). There was no significant association between service type and presence of preassessment service (p = 0.42), sedation policy (p = 0.685) or presence of a sedation lead (p = 0.08). The majority of acute services have a gastrointestinal bleed (GIB) service (82.2%) but provision is significantly different between regions (p < 0.001). Accreditation (p < 0.01) and AS lists (p < 0.01) were strongly associated with having a GIB service. Overall, 66.1% of services reported having an effective strategy for supporting underperformance. More endoscopists require support for technical skills than non-technical skills (p = 0.001). Simulation provision was 49.1% across acute services, with significant regional differences (p = 0.001). Learning is shared following discussion of adverse events in 94.1% services. Patient feedback is used primarily to support learning, training and quality improvement.ConclusionsThis is the first survey of national endoscopy safety practice and highlights regional and service-specific variability. These results are important in guiding the ISREE strategy forwards in supporting safer UK endoscopy.