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

OBJECTIVES: 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.

INTRODUCTION: 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.

METHODS: 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.

RESULTS: Improvements in practice were observed for all eight criteria. The most significant improvements were for the following criteria: an organizational policy exists, 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.

CONCLUSIONS: 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.