SCALE-ENDO

Study of Communication and Adaptive capacity using in-situ Learning Environments based on real life risks in ENDOscopy (SCALE-ENDO)

The medical sector continuously strives to enhance patient safety and reduce the risk of adverse events, which can significantly impact patients, staff, and the healthcare system. While active failures may appear as individual or team actions at the bedside, they often stem from underlying systemic and organisational conditions. To minimise these risks, it is crucial to understand the factors that predispose individuals, teams, systems, and organisations to errors.

Gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool, yet it operates in a high-risk environment. Although advancements in technical skills are pursued through training and professional development, non-technical skills have been identified as critical factors influencing clinical outcomes during endoscopy. While adverse events are documented in national databases, there is a notable gap in research regarding the contributory factors within their context.

Adverse events in this setting are reported to the National Reporting and Learning System (NRLS). Narratives submitted by frontline staff following such events provide rich information on individual, local, and organisational factors that have influenced patient outcomes. In-situ simulation has already proven to be a powerful tool in enhancing self-reported staff confidence, communication, and leadership.

The SCALE-ENDO project aims to improve safety in gastrointestinal endoscopy by developing and evaluating team-based in-situ simulations, grounded in real-world risks in endoscopy settings as identified through a mixed-methods analysis of endoscopy incidents and near-misses from the NRLS database.

Using innovative video-based methods within a multi-qualitative-method evaluation of in-situ endoscopy simulations, the study will generate novel insights into the interaction and adaptation of multi-professional endoscopy teams to deliver safe endoscopy care. This work will draw insights from an interdisciplinary team with expertise in safety science, human factors, medical education, communication, and gastrointestinal endoscopy.

Objectives

1. Identify recurring themes related to factors contributing to patient safety incidents and near-misses in gastrointestinal endoscopy.
2. Integrate patient safety themes into multi-disciplinary in-situ simulated endoscopy training.
3. Evaluate the learning experience using language-based analyses of reflective debrief videos after simulations and semi-structured participant interviews.
4. Investigate the impact of latent factors and active failures on team performance, with a focus on team communication.
5. Assess the efficacy of systems (such as endoscopy protocols, practices, and technologies) promoting safety in endoscopy settings through video analyses of simulations.
6. Develop an evidence-based framework for learning from safety incidents using simulation.

Project team

Chief Investigator

• Dr M Farhad Peerally, University of Leicester and Kettering General Hospital

Co-investigators

• Dr Michelle O’Reilly, University of Leicester
• Dr Debasish Das, University of Leicester and Kettering General Hospital
• Professor Andrew Chilton, Kettering General Hospital
• Dr Sudarshan Kadri, University Hospitals of Leicester

Clinical Research Fellow

• Dr Sam Little, University of Leicester and Kettering General Hospital

Other team members

• Dr James Tawn – Academic Foundation Doctor
• Dr Myrto Vlazaki – Academic Foundation Doctor

Funders

• The Medical Protection Society Foundation is the main funder, providing £200,000 over two years
• The project is further supported by a small grant from the Midlands Gastroenterology Society