Introduction Patients undergoing emergency endoscopy are acutely unwell, often comorbid with higher mortality compared to routine cases. Therapeutic intervention is likely and procedures may be conducted out of hours in less familiar environments. There is a longer learning curve, posing challenges for skill acquisition and retention. NCEPOD identified good decision-making and teamwork as areas for improvement for patient safety in urgent cases. The Upper GI Bleed Toolkit sets quality standards for 24/7 service provision. However, variation exists on when urgent procedures are performed, equipment availability, endoscopy teams, procedure setting and access to senior supervision. This study investigated whether the endoscopist’s performance in technical and non-technical skill is also implicated.
Methods Aims: To compare performance in urgent/emergency (E) and routine (R) GI endoscopy in a tertiary unit. A prospective observational comparative study was conducted with live ratings of technical skill (DOPS 1–4*) non-technical skill (ENTS 1–4*), degree of completion of a 13 item endoscopy safety checklist (SC) and Patient Safety Incidents (PSI). Over 2 months, consecutive E cases were live rated by an independent trained observer using validated tools. R cases matched for endoscopist experience and procedure were rated within the following 24 h. Wilcoxon and t tests were used to compare paired E and R data and Spearman’s rank was used to examine correlation between the different variables. (*1 = poor 4 = excellent)
Results 41 E & 41 R cases performed by independent endoscopists on the on-call GIB rota were assessed. All variables were poorer for E compared to R cases (Table). ENTS, DOPS and SC completion were positively correlated. PSI were inversely correlated with ENTS, DOPS and SC completion (Image)
Conclusion Performance in urgent/emergency endoscopy was significantly poorer than for routine procedures and resulted in more PSI. Different technical and non-technical skills may be required for emergency endoscopy. In these complex higher-risk cases, poorer non-technical skills and suboptimal checklist completion may be negatively impacting technical performance in endoscopists who perform well in the routine setting. These offer targeted training opportunities and performance assessments to enhance safety and quality.
Disclosure of Interest None Declared
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