Teamworking in endoscopy: a human factors toolkit for the COVID-19 era

Abstract

Background Endoscopy services have had to rapidly adapt their working practices in response to COVID-19. As recovery of endoscopy services proceeds, our workforce faces numerous challenges that can impair effective teamworking. We designed and developed a novel toolkit to support teamworking in endoscopy during the pandemic.

Methods A human factors model was developed to understand the impact of COVID-19 on endoscopy teams. From this, we identified a set of key teamworking goals, which informed the development of a toolkit to support several team processes. The toolkit was refined following expert input and refinement over a 6-week period.

Results The toolkit consists of four cognitive aids that can be used to support team huddles, briefings, and debriefs, alongside techniques to optimize endoscopic nontechnical skills across the patient-procedure pathway. We describe the processes that local endoscopy units can employ to implement this toolkit.

Conclusion A toolkit of cognitive aids, based on human factors principles, may be useful in supporting teams, helping them adapt to working safely in the era of COVID-19.

• References

• 1 Edwards C, Penman ID, Coleman M. Gastrointestinal endoscopy during COVID-19: when less is more. Frontline Gastroenterol 2020; 11: 256-257
• 2 Penman I, Edwards C, McKinlay A. British Society of Gastroenterology guidance on recommencing gastrointestinal endoscopy in the deceleration and early recovery phases of COVID-19 pandemic. British Society of Gastroenterology. 2020 https://www.bsg.org.uk/covid-19-advice/bsg-guidance-on-recommencing-gi-endoscopy-in-the-deceleration-early-recovery-phases-of-the-covid-19-pandemic/ (Accessed: 7 June 2020)
• 3 Hayee B, Thoufeeq M, Rees CJ. et al. Safely restarting GI endoscopy in the era of COVID-19. Gut 2020;
• 4 Joint Advisory Group on Gastrointestinal Endoscopy. Supplementary environment guidance following the COVID-19 pandemic. Joint Advisory Group on Gastrointestinal Endoscopy. 2020 https://www.thejag.org.uk/covid-environment-guidance (Accessed: 7 June 2020)
• 5 Gralnek IM, Hassan C, Beilenhoff U. et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; 52: 483-490
• 6 Schmutz J, Manser T. Do team processes really have an effect on clinical performance? A systematic literature review. Br J Anaesth 2013; 110: 529-544
• 7 Karsh BT, Holden RJ, Alper SJ. et al. A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional. Qual Saf Health Care 2006; 15 (Suppl. 01) i59-i65
• 8 Ravindran S, Haycock A, Woolf K. et al. Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system. BMJ Simul Technol Enhanc Learn 2020;
• 9 The Clinical Human Factors Group. Key Human Factors messages when working under pressure. Clinical Human Factors Group. 2020 https://chfg.org/what-are-clinical-human-factors/ (Accessed 7 June 2020)
• 10 Franklin BJ, Gandhi TK, Bates DW. et al. Impact of multidisciplinary team huddles on patient safety: a systematic review and proposed taxonomy. BMJ Qual Saf 2020;
• 11 Hicks CW, Rosen M, Hobson DB. et al. Improving safety and quality of care with enhanced teamwork through operating room briefings. JAMA Surg 2014; 149: 863-868
• 12 Goldenhar LM, Brady PW, Sutcliffe KM. et al. Huddling for high reliability and situation awareness. BMJ Qual Saf 2013; 22: 899
• 13 Salas E, Klein C, King H. et al. Debriefing medical teams: 12 evidence-based best practices and tips. Jt Comm J Qual Patient Saf 2008; 34: 518-527
• 14 Jaye P, Thomas L, Reedy G. ‘The Diamond’: a structure for simulation debrief. Clin Teach 2015; 12: 171-175
• 15 Ellis R, Hay-David AGC, Brennan PA. Operating during the COVID-19 pandemic: how to reduce medical error. Br J Oral Maxillofac Surg 2020; 58: 577-580