Ravindran Srivathsan, Thomas-Gibson Siwan, Murray Sam, Wood Eleanor
Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Frontline Gastroenterol. 2019 Apr;10(2):160-166. doi: 10.1136/flgastro-2018-101078. Epub 2019 Jan 9.
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.
患者安全事件在整个医疗保健领域都会发生，早期报告揭示了“人为因素”的缺陷是如何导致内镜检查中的死亡案例的。认识到这一点后，在英国，胃肠内镜检查联合咨询小组已经实施了多项举措，包括“提高内镜检查安全性和减少错误”（ISREE）战略。在此战略框架内，正在开展人为因素和内镜非技术技能（ENTS）方面的模拟培训。在整个医疗保健领域，模拟培训已被证明能提高团队技能并改善患者治疗效果。尽管相关文献较少，但综合模拟和现场模拟模式在内镜检查中已显示出前景。结果表明，个人和团队的表现得到改善，有助于临床实践的技能也得到了发展。此外，利用模拟培训来发现工作环境中的潜在错误对于减少错误和预防伤害具有重要价值。通过组织、教育和临床负责人之间的合作，可以在地方和区域层面成功实施模拟培训。在全国范围内，模拟策略是ISREE战略中改善ENTS培训的关键方面。这些策略可能包括将模拟融入当前培训或开发基于模拟的全新课程。无论如何使用，很明显模拟培训是发展更安全的内镜检查的重要工具。
