ObjectiveIn situ simulation (ISS) is an effective training method for multiprofessional teams dealing with emergencies in high pressured environments. A regular ISS programme was organised for the multiprofessional gastroenterology team with a primary objective of identifying, classifying and addressing latent patient safety threats and secondary objectives of improving team confidence and individual role recognition.Method22 unannounced ISS sessions (averaging approximately one session every 6 weeks and four participants per session) were conducted between February 2017 and August 2019 involving multiprofessional team members. The sessions centred around the following four common gastrointestinal emergency scenarios: massive upper gastrointestinal haemorrhage; biliary sepsis (cholangitis) and shock; postendoscopic retrograde cholangiopancreatography complications including perforation and cardiac arrest. Following the simulation, the faculty, which included nurses and doctors, facilitated a structured debrief session and action plan to identify and address latent errors.Results96 participants from nursing, medical, physician associate and pharmacy backgrounds took part in the simulation programme. Analysis of collected latent safety threats identified the following four themes: education and training; equipment; medication and team working. Analysis of anonymously completed questionnaires identified that 95% of participants had a perceived better understanding of their role and 86% felt more confident in assessing an unwell patient. 96% of participants felt comfortable during the debrief.ConclusionISS provides a unique opportunity to train the multiprofessional gastroenterology team in their own high-pressured environment, helping identify and address latent patient safety threats and improve perceived participant confidence and role recognition.

Methods the following data about endoscopists in screening programs between 201-017 were collected: age, sex, years as physician, specialization, annual colonoscopy volume. During 201-014, younger endoscopists (<40 yr) underwent four meetings with a senior endoscopist (Cristopher Williams), to improve general endoscopic ability and, in particular, the sensibility to detect adenomatous lesions. ADR was calculated for each operator. Data were analyzed with SPSS program. Results During the three year period, 191 endoscopists performed a total of 42,706 first colonoscopies after FIT positivity. One hundred forty with at least 20 colonoscopies after FIT positivity/yr, (mean age 48.2yr ± 10.8yr (M±SD), Male 53.9%) were selected. Three hundred eight-two ADRs were collected during the observation period. Overall ADR was 43.7±9.5%. Ninety-six of the endoscopists were specialized in gastroenterology, 35 in general surgery, and 8 in other specialities. ADR was 44.1± 9.7% for the gastroenterologists, 42.7 ±9.6% for the surgeons (p=ns) and 39.5 ±7% for those with other specialities (p=0.033). ADR was significantly higher for the younger endoscopists (3-9yr 47.5%; 4-9yr 44.6%; >50yr 41.4%, with p<0.001). The ADRs over the three year period were similar (44.2% vs 42.9% vs 43.3%, p= ns). No significant association between ADR and number of screening colonoscopies performed weew found. When the ADR in 2017 of 81 endoscopists was analyzed depending on the cumulative number of total colonoscopies/yr, it was found that the those with > 300 colonoscopies/yr had higher ADRs ( 35.5 ±21.4% vs 43.5±11.5%, p=0.04) in colonoscopies after FIT positivity/yr . Conclusions Study findings demonstrated that junior endoscopists and those specialized in gastroenterology were more effective in identifying adenomas during screening colonscopy procedures. High annual colonoscopy volumes and working exclusively as endoscopists but not years of experience or being older were associated with higher ADRs. Educational interventions seemed to be effective in improving sensitivity and performance.

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