Endoscopy 2018; 50(03): 203-210
DOI: 10.1055/s-0043-121218
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Implementation of a checklist before colonoscopy: a quality improvement initiative

Omar Kherad*
1  Department of Internal Medicine, La Tour Hospital and University of Geneva, Geneva, Switzerland
2  Safety, Quality, Informatics and Leadership Program, Harvard Medical School, Boston, Massachusetts, United States
Sophie Restellini*
3  Division of Gastroenterology, McGill University, Montreal, Canada
4  Division of Gastroenterology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
Charles Ménard
5  Department of Medicine, University of Sherbrooke, Sherbrooke, Canada
Myriam Martel
3  Division of Gastroenterology, McGill University, Montreal, Canada
Alan Barkun
3  Division of Gastroenterology, McGill University, Montreal, Canada
6  Department of Clinical Epidemiology, McGill University, Montreal, Canada
› Author Affiliations
Further Information

Publication History

submitted 01 June 2017

accepted after revision 14 September 2017

Publication Date:
13 December 2017 (eFirst)


Background and study aims Checklists can prevent errors and have a positive impact on patient morbidity and mortality in different surgical settings, and possibly also in gastrointestinal endoscopy. The aims of this study were to reinforce commitment in safety culture and better communication among team members in endoscopy, and to prove the feasibility of successful checklist adoption before colonoscopy.

Patients and methods The study involved a pre – post quality improvement intervention involving all consecutive patients undergoing a colonoscopy at a single academic endoscopy unit. The first part of the study was a retrospective audit, carried out over a 3-month period (July to September 2016). A checklist developed through a formal validation process was implemented during the intervention period (October to December 2016). Primary outcomes were changes in patient and team satisfaction after the quality improvement intervention, using validated 5-point scale questionnaires. Secondary outcomes included successful procedure completion rates and safety outcomes.

Results During the baseline and comparative intervention period, 1317 and 1141 colonoscopies, respectively, were performed. Overall, checklists were fully completed by nurses and physicians for 791 patients (69.3 %). Mean overall patient satisfaction was high at baseline and did not differ following the quality improvement intervention (4.66 vs. 4.63; P  = 0.5). Perception of team communication and teamwork was improved after checklist implementation. Comparative analyses of per-procedure and safety outcomes did not differ between the pre- and post-checklist implementation.

Conclusion Adoption of an endoscopy checklist before colonoscopy is feasible, and significantly increases perception of team communication and teamwork. Additional studies are needed to assess the generalizability of these results to complex endoscopic procedures and to characterize any improvement in patient safety outcomes.

* These authors contributed equally to this work.