Discharge following sedation for endoscopic procedures: a best practice implementation project.

Abstract

The aim of this project was to promote best discharge practice in sedated patients following endoscopic procedures in an endoscopy tertiary center in Shanghai, China. Discharge of sedated patients is the final stage of the endoscopic procedure. Healthcare providers must ensure patient safety through timely and appropriate discharge from endoscopic procedures. A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System tool. Eight audit criteria that were representative of best-practice recommendations for the discharge of sedated patients following endoscopic procedures were used. A baseline audit was conducted, followed by the implementation of multiple strategies that were determined by the key stakeholders. The project was finalized with a follow-up audit to determine change in practice. Improvements in practice were observed for all eight criteria. The most significant improvements were for the following criteria: an organizational policy exists for patient discharge after endoscopy, minimum discharge criteria are established, minimum discharge criteria are met before the patient is discharged (each from 0% to 100% compliance), patient received written and verbal discharge instructions (from 12% to 100% compliance), and discharge care plan is documented in the patient's medical file (from 0% to 88%). Criteria 4 (discharge is authorized by an appropriate staff member), 6 (staff member is appropriately trained and educated) and 7 (patient is accompanied by a responsible adult) achieved the least improvement in compliance rates, as baseline measures already showed a high degree of compliance. Overall, there was improvement in compliance for all best-practice recommendations. The project demonstrated positive changes in the discharge care of sedated patients following endoscopic procedures in an endoscopy tertiary center in Shanghai, China. A formalized organizational discharge policy is currently in place and a continuous cycle of audit and re-audit will need to be carried out in the future to keep the quality at a high and steady level.