PWE-423 Human factors training (hft) through simulation based scenarios in endoscopic haemostasis improves teamworking

Abstract

Introduction In the early 1970s, number of air crashes were attributed to human error. HFT is well recognised for improving safety in aviation. Medical errors rank high amongst the leading causes of death and HFT is increasingly been recognised to reduce errors in CPR and anaesthetics. The value of HFT in endoscopy has not been evaluated. Method We delivered haemostasis and HFT to Gastroenterology Specialty trainee Registrars (StRs) at Lancashire simulation centre. A computer-based life-sized manikin with human physiology emulation capability was used. Its vital signs were controlled remotely. The manikin could talk and was connected to ECG, Pulse rate, SpO2 and BP monitor. Endoscopy equipment and porcine stomach models were used. Haemostatic methods including adrenaline injection, haemoclip placement, Haemospray, Sengstaken tube and Danis stent insertion were practiced. Introductory presentations on Human factors were delivered. 4 scenarios were written to provide ‘high-stress/high-stakes’ events that are encountered infrequently, but where rapid and professional responses are crucial i.e. patients with an upper GI bleed developing periarrest whilst in endoscopy unit. Each scenario involving 5 to 6 StRs was facilitated by Gastroenterologists and Simulation skills educators. Feedback was provided by peer observation. Microteaching was delivered using video assisted debrief. Pre and post course feedback was obtained. Results 23 StRs attended. Prior to this course 55% StRs have had no HFT, 14% had self directed learning, 9% received lectures and 22% had formal workshop based HFT. Data analysis showed improvement in all areas of Human Factor: decision making, situational awareness, team working and leadership skills. On the Likert scale (1 strongly disagree, 5 strongly agree) StRs felt scenarios were useful (Median 5, IQR 1), amount of information was appropriate (Median 5, IQR 1) and hands on training was useful (Median 5, IQR 1). StRs reported increased awareness of managing acutely ill patients in relation to sedation issues (Median 4, IQR 2), principles of resuscitation and fluid management (Median 4, IQR 2), improved leadership, teamwork and communication (Median 5, IQR 1). Qualitative feedback was positive. StRs however recommended smaller groups in future courses. 90% StRs felt that training on Human Factors and their influence on patient safety should be compulsory. Conclusion Human patient simulation provides ‘real life’ environment to observe Human Factors and allows chance to debrief, something that is difficult in the busy workplace. StRs benefit from HFT and report improvement in their skills. We recommend that HFT in endoscopy should be incorporated in competency based training curriculum and rolled out nationally. Disclosure of interest None Declared.