Anton V Emmanuel

Real-life experience to improve endoscopy outcomes: optimising teamwork and metrics The degree of patient co-morbidity is well recognised as significant contributor to the outcome of patients presenting with an upper gastrointestinal bleed (UGIB). In this edition of Frontline Gastroenterology Taha et al have published a single centre series of 2669 patients over 15 years which confirms the impression of frontline endoscopists that the patients they are seeing are getting increasingly more complex and more unwell. They also suggest that the introduction of a multidisciplinary approach for this growing complexity of case-mix has resulted in improved outcomes. The journal has published several high quality articles looking at provision of UGIB services, and this paper adds to that in helping define what a multidisciplinary approach can bring to this common problem. We have also published a series of articles on quality improvements in colonoscopy, and are delighted to publish more in this edition to complement those. Vaughan-Shaw et al have investigated a large series of repeat colonoscopies from a single endoscopy training centre over three years. With the burgeoning of possible metrics of colonoscopy outcome it is proposed that the detection of new pathology in such repeat procedures be included. Another aspect of quality improvement that we can learn from in endoscopy is the improvements in surgical safety brought about by the introduction of checklists. The St Mark’s group have implemented such an endoscopy unit checklist and Matharoo et al describe the lessons learned from their experience. As well as sharing the checklist itself they also provide a videolink to demonstrate its utility and potential to improve safety and teamwork. Increasing patient choice through tailoring pain relief is another potential key metric in endoscopy units. Ball et al report a survey of UK bowel cancer screening colonoscopists in the UK which highlights that whilst Entonox is generally thought to be effective and convenient, it is used relatively infrequently. Interestingly, most colonoscopists would opt to receive Entonox themselves if they had to have the procedure. The final themed article in this edition is the Curriculum Based review (with BMJ Learning module online) by Mohanaruban et al. They provide a practical and complete review of the process of consenting for endoscopy.