Importance of non-technical skills: SACRED in advanced endoscopy

NTS in gastrointestinal endoscopy were not fully appreciated until the landmark 2004 National Confidential Enquiry into Patient Outcome and Death report highlighted their deficiencies as a contributory factor to 30-day mortality following therapeutic procedures.1 The landscape of endoscopy changed, and the development of quality assurance and training programmes began. A randomised controlled trial of a dedicated NTS training curriculum for novice endoscopists, incorporating the novel Non-Technical Skills for Endoscopy checklist, demonstrated significantly improved NTS scores and overall colonoscopy performance (assessed using four domains: assessment, consent and communication, safety and sedation, endoscopic skills, and diagnostic and therapeutic utility).5 This is supported by national training data in the UK, which shows that ENTS scores improve over time during training and correlate well with other key performance indicators or markers of competency.6 Team-ENTS In recognising the crucial role of understanding ENTS in the performance of an endoscopist, there is now an increasing shift towards developing the endoscopy team as a whole. No matter how good the communication of the endoscopist is, if the team is distracted or disengaged, the outcome may not be as optimal as with a fully prepped and vigilant team. [...]effective teamworking should incorporate other safety-critical processes including safety huddles, briefings, debriefings and a ‘time out’ to conduct the endoscopy safety checklist. The ‘Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills’ framework outlines five key NTS domains for endoscopy teams: communication, decision-making, planning and problem-solving, leadership and coordination, situation awareness and, teamwork, cooperation and support.7 This framework provides a template for team training and assessment in endoscopy, which addresses the non-technical and behavioural skills that are vital to team performance.