Improving safety and reducing error in endoscopy: simulation training in human factors

Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in ‘human factors’ have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.

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In-situ child and adolescent mental health simulation with human factors feedback delivered by airline pilots

BJPsych Open ◽

10.1192/bjo.2021.388 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S136-S136

Author(s):

Megan Fisher ◽

Alexander Jolly ◽

Mumtaz Mooncey ◽

Kerry Robinson ◽

Robert Lloyd ◽

...

Keyword(s):

Mental Health ◽

Human Factors ◽

Positive Feedback ◽

Multidisciplinary Team ◽

Simulation Training ◽

High Stress ◽

Adolescent Mental Health ◽

In Situ Simulation ◽

Airline Pilots

AimsTo encourage multidisciplinary team learning by introducing Child & Adolescent Mental Health (CAMHS) in-situ simulation training.To provide focused Human Factors feedback through the expertise of senior airline pilots.MethodThe integration of the WingFactors in-situ simulation programme to multiple departments at Whittington Health NHS Trust has transformed the education landscape. The programme has received unanimously positive feedback, and the potential benefits for not only physical, but also mental health training, have been quickly recognised. A total of 90 simulations have been performed. A number of CAMHS scenarios have been designed with the primary aims of encouraging multidisciplinary training and increasing the focus on Human Factors in Psychiatry.Simulation scenarios were performed in real clinical environments with primed actors, thus enabling high-fidelity in-situ simulation. Immediate ‘hot’ debriefs were delivered by clinical faculty and uniformed airline pilots, with emphasis on psychological safety to encourage participation from all team members. The key learning points were then detailed in written documents and circulated to the wider team as a valuable learning resource.The first CAMHS simulation involved the acute management of a collapsed patient in the Emergency Department toilet, with a ligature tied around her neck and accompanied by a distressed patient. Another scenario addressed de-escalation techniques when dealing with a patient presenting with an overdose, who was threatening to leave the ward and posing potential risk to herself.ResultThe nature of these in-situ simulations enabled the multidisciplinary team to analyse practical considerations in the management of acute clinical situations. Scenarios were designed to focus on areas which had been identified as needing improvement for patient safety.The observations provided by airline pilots increased the focus on Human Factors training. A number of key themes were identified, including the importance of effective team-briefing, distraction management and task allocation. This is of particular significance when managing a distressed patient and anxious relative, in a busy high-stress clinical environment.ConclusionIn-situ simulation is a newly emerging concept in the field of Psychiatry, and the success of this programme has been highlighted through consistently positive feedback from participants, and nomination for the HSJ Award (Best Education Programme 2021). The involvement of airline pilots has promoted collaborative learning amongst the multidisciplinary team, and increased the focus on Human Factors in Psychiatry, clearly demonstrating the value of in-situ simulation training in this field.

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National implementation of in situ simulation training in Helicopter Emergency Medical Services: A multicenter study

10.21203/rs.3.rs-71574/v1 ◽

2020 ◽

Author(s):

Per P. Bredmose ◽

Jo Røislien ◽

Doris Østergaard ◽

Stephen Sollid

Keyword(s):

Simulation Training ◽

Emergency Services ◽

Successful Implementation ◽

In Situ Simulation ◽

National Implementation ◽

Simulation Based ◽

Key Factor ◽

One Year ◽

Implementation Factors

Abstract IntroductionMedical simulation is used in helicopter emergency services as a tool for training the crew. Using in situ simulation we aimed to evaluate the degree of implementation, factors for successful simulation and the crew’s attitude towards this form for training.MethodsA one year prospective study on simulation at all Norwegian helicopter emergency services bases and one search and rescue base. Local facilitators were educated and conducted simulations at their own discretion.ResultsAll bases participated, but the number of simulations attempted at each base varied from 1 to 46. Busier bases had a significantly higher number of aborted simulations. Regardless of base and number of attempted simulations, participating crews scored self-evaluated satisfaction with this form of training highly. The number of local facilitators and their travel distance to work seemed to make no difference to the number of attempted simulations.DiscussionOur study reveals large differences in the number of attempted simulations between bases. Our findings suggest that the local facilitator is a key factor for successful implementation of simulation based training in helicopter emergency services.

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Challenges to the implementation of in situ simulation at HEMS bases: a qualitative study of facilitators’ expectations and strategies

Advances in Simulation ◽

10.1186/s41077-021-00193-x ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Per P. Bredmose ◽

Doris Østergaard ◽

Stephen Sollid

Keyword(s):

Qualitative Study ◽

Simulation Training ◽

Successful Implementation ◽

Management Support ◽

In Situ Simulation ◽

National Implementation ◽

Simulation Based ◽

Before And After ◽

One Year

Abstract Introduction Facilitators play an essential role in simulation-based training on helicopter emergency medical services (HEMS) bases. There is scant literature about the barriers to the implementation of simulation training in HEMS. The purpose of this explorative interview study was to identify factors that the local facilitators anticipated would challenge the smooth implementation of the program, and their strategies to overcome these before the national implementation of in situ simulation-based training locally, and subsequently, one year after the programme was initiated, to identify the actual challenges they had indeed experienced, and their solutions to overcome these. Methods A qualitative study with semi-structured group interviews of facilitators was undertaken before and after one year of simulation-based training on all HEMS bases and one Search and Rescue base. Systematic text condensation was used to extract facilitators’ expectations and experiences. Results Facilitators identified 17 themes in the pre-study-year interviews. Pedagogical, motivational and logistical issues were amongst the dominant themes. Other key themes included management support, dedicated time for the facilitators and ongoing development of the facilitator. In the post-study-year interviews, the same themes were identified. Despite anxiety about the perceptions of, and enthusiasm for, simulation training amongst the HEMS crews, our facilitators describe increasing levels of motivation over the study period. Conclusion Facilitators prognosticated the anticipated challenges to the successful implementation of simulation-based training on HEMS bases and suggested solutions for overcoming these challenges. After one year of simulation-based training, the facilitators reflected on the key factors for successful implementation.

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125 INTRODUCING AN IN SITU SIMULATION PROGRAMME IN AN INTENSIVE CARE UNIT

International Journal of Healthcare Simulation ◽

10.54531/whpg6255 ◽

2021 ◽

Author(s):

Harry Bateman ◽

Karen Johnston ◽

Andrew Badacsonyi ◽

Natalie Clarke ◽

Kathleen Conneally ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Human Factors ◽

Professional Training ◽

In Situ Simulation ◽

Airline Pilots ◽

Staff Members ◽

Emergency Scenarios ◽

The Impact

This North London hospital has a 14-bed Intensive Care Unit (ICU). As a small District General ICU, staff exposure to emergency scenarios can be infrequent. Lack of practice can lead to a reduction in staff confidence and knowledge when these scenarios are encountered, especially during the COVID pandemic. The ICU had not previously undertaken in situ multi-disciplinary team (MDT) simulation sessions on the unit.The aim of the study was to introduce a novel programme of MDT simulation sessions in the ICU and provide feedback with the aim of increasing both staff confidence in managing emergency scenarios and staff understanding of the impact of human factors.A team of ICU Simulation Champions created emergency scenarios that could occur in the ICU. Pre-simulation and post-simulation questionnaires were produced to capture staff opinion on topics including benefits and barriers to simulation training and confidence in managing ICU emergencies. Members of the ICU MDT would be selected to participate in simulation scenarios. Afterwards, debrief sessions would be facilitated by Simulation Champions and Airline Pilots with a particular focus on competence in managing the emergency and human factors elements, such as communication and leadership. Participants would then be surveyed with the post-simulation questionnaire.Nine simulation sessions were conducted between October 2020 and June 2021. The sessions occurred within the ICU during the working day in a designated bay with the availability of all standard ICU resources and involved multiple MDT members to aid fidelity. Feedback by Simulation Champions mainly focussed on knowledge related to the ICU emergency, whilst the Airline Pilots provided expert feedback on human factors training. Fifty-five staff members completed the pre-simulation questionnaire and 37 simulation participants completed the post-simulation questionnaire. Prior to simulation participation, 28.3% of respondents agreed they felt confident managing emergency scenarios on ICU – this figure increased to 54.1% following simulation participation. 94.4% of simulation participants agreed that their knowledge of human factors had improved following the simulation and 100% of participants wanted further simulation teaching. Figure 1 shows a thematic analysis of the responses from 31 participants who were questioned about perceived benefits from simulation teaching. Following the success of the programme, the Hospital Trust will continue to support and develop inter-speciality and inter-professional training, and have funded the appointment of an ICU Simulation Fellow to continue to lead and enhance future in situ simulation teaching on the ICU.

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