Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Ching, Hey-Long; Lau, Michelle S; Azmy, Iman; Hopper, Andrew D; Keuchel, Martin; Gyökeres, T; Kuvaev, Roman; Macken, Elisabeth; Bhandari, Pradeep; Thoufeeq, Mo; Leclercq, Philippe; Rutter, Matthew D.; Veitch, Andrew; Bisschops, Raf; Sanders, David S.

doi:10.1055/a-1832-4232

Cited by 10 publications

(12 citation statements)

References 95 publications

(132 reference statements)

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“…Because the way endoscopy is delivered globally varies, the research team felt that grounding this study in one region to develop a preliminary tool suited the research aims. Since development and delivery of this study, there has however been increasing global focus on the importance of teamworking in endoscopy [35]. The generalizability of the tool may therefore be limited, particularly if excluding other endoscopy team members who are not employed within the UK, such as endoscopy technicians in the USA and Europe.…”

Section: Discussionmentioning

confidence: 99%

Development of the “Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills” (TEAM-ENTS) behavioral marker system

Ravindran

Cavilla²,

Ashrafian

et al. 2022

Endoscopy

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Background and study aims Non-technical skills (NTS) are integral to team performance and subsequent quality and safety of care. Behavioural marker systems (BMS) are now increasingly used in healthcare to support training and assessment of team NTS. Within gastrointestinal endoscopy, this is an area of novel research. The aims of this study were to define the core relevant NTS for endoscopy teams and develop a preliminary framework for a team-based BMS known as TEAM-ENTS (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills). Methods This study was conducted in two phases. In phase 1, a literature review of team-based BMS was performed to inform an interview study of core endoscopy team members. Cognitive task analysis was used to breakdown the NTS relevant to endoscopy teams. Framework analysis generated the structure for the preliminary TEAM-ENTS framework. In phase 2, a modified Delphi process was undertaken to refine items of the framework. Results Seven consultant endoscopists and six nurses were interviewed. The final coding framework consisted of 88 codes grouped into 5 overarching categories. In total, 58 participants were recruited to the Delphi panel. In the first round, 9 elements and 37 behavioural descriptors did not meet consensus. Following item adjustment, merging and deletion, all remaining items met consensus thresholds after the second round. The refined TEAM-ENTS BMS consists of 5 categories, 16 elements and 47 behavioural descriptors. Conclusions The refined TEAM-ENTS behavioural marker system was developed to reflect the core non-technical skills relevant to endoscopy teams. Future studies will aim to fully validate this tool.

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Section: Discussionmentioning

confidence: 99%

Development of the “Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills” (TEAM-ENTS) behavioral marker system

Ravindran

Cavilla²,

Ashrafian

et al. 2022

Endoscopy

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“…Briefing and debriefing models have also been developed to support processes around each endoscopy procedure or list [34]. There may be approaches to improving performance in specific team settings such as 'SACRED' in advanced endoscopy [35].…”

Section: Team Performancementioning

confidence: 99%

Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents from the National Reporting and Learning System (NRLS)

Ravindran,

Matharoo,

Rutter

et al. 2023

Endoscopy

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BACKGROUND AND AIMS Despite advances in understanding and reducing risk of endoscopic procedures, there is little consideration of the safety of the wider endoscopy service. Patient safety incidents (PSIs) still occur. We sought to identify non-procedural PSIs (nPSIs) and their causative factors from a human factors perspective and generate ideas for safety improvement. METHODS Endoscopy-specific PSI reports were extracted from the National Reporting and Learning System (NRLS). A retrospective, cross-sectional human factors analysis of data was performed. Two independent researchers coded data using a hybrid thematic analysis approach. The Human Factors Analysis and Classification System (HFACS) was used to code contributory factors. Analysis informed creation of driver diagrams and key recommendations for safety improvement in endoscopy. RESULTS From 2017 – 2019, 1181 endoscopy-specific PSIs of significant harm were reported across England and Wales. Of these, 539 (45.6%) were nPSIs. Five categories accounted for over 80% of all incidents with ‘follow up and surveillance’ being the largest (23.4% of all nPSIs). 487 human factors codes were identified from free-text incident reports. Decision-based errors were the most common act prior to PSI occurrence. Preconditions to incident focussed on environmental factors, particularly overwhelmed resources, patient factors, and ineffective team communication. Lack of staffing, standard operating procedures, effective systems, and clinical pathways were also contributory. Seven key recommendations for improving safety are made in response to our findings. CONCLUSIONS This was the first national-level human factors analysis of endoscopy-specific PSIs. This work will inform safety improvement strategies and should empower individual services to review their approach to safety.

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“…We require a more holistic view of teamworking, particularly in advanced therapeutic endoscopy, and that is, where we introduce the concept of SACRED (table 1). The six key principles of SACRED attempts to address the non-technical demands of advanced endoscopy teams and services 9. By following these principles, advanced endoscopy teams can improve their performance and ensure effective delivery of high-quality care throughout the patient’s journey.…”

Section: The Next Steps: Sacredmentioning

confidence: 99%

Importance of non-technical skills: SACRED in advanced endoscopy

Shiha

Ravindran

Thomas‐Gibson

et al. 2023

Frontline Gastroenterol

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Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Cited by 10 publications

References 95 publications

Development of the “Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills” (TEAM-ENTS) behavioral marker system

Development of the “Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills” (TEAM-ENTS) behavioral marker system

Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents from the National Reporting and Learning System (NRLS)

Importance of non-technical skills: SACRED in advanced endoscopy

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