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Original research
Improving safety and reducing error in endoscopy (ISREE): a survey of UK services
  1. Srivathsan Ravindran1,2,
  2. Paul Bassett3,
  3. Tim Shaw4,
  4. Michael Dron4,
  5. Raphael Broughton4,
  6. Helen Griffiths1,
  7. Dimple Keen1,
  8. Eleanor Wood5,6,
  9. Chris J Healey1,7,
  10. John Green8,
  11. Hutan Ashrafian2,
  12. Ara Darzi2,
  13. Mark Coleman1,9,
  14. Siwan Thomas-Gibson2,10
  1. 1Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
  2. 2Surgery and Cancer, Imperial College London, London, London, UK
  3. 3Statsconsultancy, Amersham, UK
  4. 4Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK
  5. 5Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, London, UK
  6. 6Simulation Centre, Homerton University Hospital NHS Foundation Trust, London, London, UK
  7. 7Gastroenterology and Hepatology Services, Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK
  8. 8Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, Cardiff, UK
  9. 9Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, Plymouth, UK
  10. 10Wolfson Endoscopy Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
  1. Correspondence to Dr Srivathsan Ravindran, Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London NW1 4LE, UK; sravindran1{at}


Background The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy was developed in 2018. In line with the strategy, a survey was conducted within the JAG census in 2019 to gain further insights and understanding of key safety-related areas within UK endoscopy.

Methods Questions were developed using the ISREE strategy as a guide and adapted by key JAG stakeholders. They were incorporated into the 2019 JAG census of UK endoscopy services. Quantitative and qualitative statistical methods were employed to analyse the results.

Results There was a 68% response rate. There was regional variability in the provision of out-of-hours GIB services (p<0.001). Across 1 month, 1535 incidents were reported across all services. There was a significantly higher proportion of reported incidents in acute services compared with others (p<0.001). Technical and training incidents were likely to be reported significantly differently to all other incident types. 74% of services have an endoscopy-specific sedation policy and 42% have a named sedation or anaesthetic lead for endoscopy. Services highlighted a desire for more anaesthetic-supported lists. Only 66% of services stated they have an effective strategy for supporting upskilling of endoscopists. Across acute services, 56% have access to human factors and endoscopic non-technical skills (ENTS) training. Patient feedback is used in several ways to improve services, develop training and promote shared learning among endoscopy users.

Conclusions The census provides a benchmark for key safety-related characteristics of endoscopy services. These results have highlighted key areas to develop, guided by the ISREE strategy.

  • endoscopy

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  • Contributors SR conducted statistical analyses and wrote the manuscript with editorial oversight from ST-G, CJH and JG. PB verified statistical analyses. All authors contributed to question design for the census. All authors reviewed the final manuscript prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SR, CJH, JG, MC and ST-G hold or have held clinical positions at the Joint Advisory Group on GI endoscopy.

  • Patient consent for publication Not required.

  • Ethics approval Formal ethics approval for this study was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. All relevant data have been included within the article.

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