ANAPHYLAXIS IN ENDOSCOPY: LEARNING FROM ADVERSE EVENTS THROUGH IN-SITU SIMULATION

Aims To develop a novel in-situ simulation (ISS) training programme to improve learning around adverse events in endoscopy. ISS allows staff to learn and practice skills in their own clinical environment and can contribute to improved team-working and patient outcomes [1, 2].

Methods Following a recent adverse event, a formal review highlighted the need to be aware of anaphylaxis and other uncommon adverse events in endoscopy. As a result, we developed an ISS programme to promote learning from and improve confidence in managing adverse events. We conducted a multidisciplinary high-fidelity session based on this case with 30 participants. Faculty included a simulated patient, consultant endoscopist, resuscitation officer and research fellow with a simulation interest. Outcomes included endoscopic non-technical skills (ENTS) confidence domains and self-reported learning points. Paired T-test was used to compare pre and post-training confidence scores and thematic analysis used to analyse participant comments. Evaluative surveys were also collected.

Results Across all 12 ENTS domains the mean pre-training confidence score was 77.9 (median 76.8, SD 4.19) and post-training score was 85.8 (median 86.1, SD 2.69). Overall, there was a statistically significant improvement in confidence across all ENTS domains after training (p < 0.001). When individual scores were compared, there was a significant improvement in 2 ENTS domains above all others: ‘maintaining focus and concentration during difficult situations’ and ‘providing emotional and cognitive support to others’. Participants’ learning outcomes were categorised into four major themes: ‘non-technical skills’, ‘education’, ‘personal skills’ and ‘patient focus’. All participants felt that ISS training enhanced multidisciplinary teamworking.

Conclusions Confidence in ENTS and learning improves with simulation training around adverse events. ISS is a versatile tool that can be useful to deliver structured training to endoscopy teams in the endoscopy unit. This has the potential to improve the quality and safety of endoscopy.