Mishra A, Catchpole K, Dale T, et al. The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy

Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
Surgical Endoscopy (Impact Factor: 3.31). 02/2008; 22(1):68-73. DOI: 10.1007/s00464-007-9346-1
Source: PubMed

ABSTRACT Evidence from other professions suggests that training in teamwork and general cognitive abilities, collectively described as non-technical skills, may reduce accidents and errors. The relationship between non-technical teamwork skills and technical errors was studied using a behavioural marker system validated in aviation and adapted for use in surgery.
26 elective laparoscopic cholecystectomies were observed. Simultaneous assessments were made of surgical technical errors, by observation clinical human reliability assessment (OCHRA) task analysis, and non-technical performance, using the surgical NOTECHS behavioural marker system. NOTECHS assesses four categories: (1) leadership and management, (2) teamwork cooperation, (3) problem-solving and decision-making, (4) situation awareness. Each subteam (nurses, surgeons and anaesthetists) was scored separately on each of the four dimensions. Two observers - one surgical trainee and one human factors expert - were used to assess intra-rater reliability.
The mean NOTECHS team score was 35.5 (95% C.I. +/- 1.88). The mean subteam scores for surgeons, anaesthetists and nurses were 13.3 (95% C.I. +/- 0.64), 11.4 (95% C.I. +/- 1.05), and 10.8 (95% C.I. +/- 0.87), respectively, with a significant difference between surgeons and anaesthetists (U = 197, p = 0.009), and surgeons and nurses (U = 0.134, p <or= 0.001). Inter-rater reliability was found to be strong (alpha = 0.88). There were between zero and six technical errors per operation, with a mean of 2.62 (95% C.I. +/- 0.55), which were negatively correlated with the surgeons situational awareness scores (rho = -0.718, p < 0.001).
Non-technical skills are an important component of surgical skill, particularly in relation to the development and maintenance of a surgeon's situational awareness. Experience from other industries suggests that it may be possible to improve the ability of surgeons to manage their own situation awareness, through training, intraoperative briefings and intraoperative workload management. In the future, it may be possible to use non-technical performance as a surrogate measure for technical performance, either for early identification of surgical difficulties, or as a method of evaluation by which non-surgically trained observers.

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    • "Non-technical skills are components of competencies and underlie a specific ability. The first study on Non-Technical Skills in the health-care setting was conducted in laparoscopic surgery (Mishra et al., 2008) and was drawn from other disciplines such as aviation. This study focused on the link between technical competence and reliability (behavioural characteristics) and is an index of competence. "
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    ABSTRACT: OBJECTIVE: The aim of this study was to identify effective corrective measures to ensure patient safety in the Paediatric Emergency Department (ED). METHODS: In order to outline a clear picture of these risks, we conducted a Failure Mode and Effects Analysis (FMEA) and a Failure Mode, Effects, and Criticality Analysis (FMECA), at a Emergency Department of a Children's Teaching Hospital in Northern Italy. The Error Modes were categorised according to Vincent's Taxonomy of Causal Factors and correlated with the Risk Priority Number (RPN) to determine the priority criteria for the implementation of corrective actions. RESULTS: The analysis of the process and outlining the risks allowed to identify 22 possible failures of the process. We came up with a mean RPN of 182, and values >100 were considered to have a high impact and therefore entailed a corrective action. CONCLUSIONS: Mapping the process allowed to identify risks linked to health professionals' non-technical skills. In particular, we found that the most dangerous Failure Modes for their frequency and harmfulness were those related to communication among health professionals.
    International emergency nursing 11/2012; 21(3). DOI:10.1016/j.ienj.2012.07.005 · 0.72 Impact Factor
    • "Effective teamwork and communication among healthcare professionals is essential to ensure quality patient care and safety. Poor communication and teamwork among healthcare providers can lead to adverse patient events, higher patient complication rates, medical errors and increased patient mortality [1] [2] . The use of team training among interprofessionals is an effective methodology when utilized to improve patient safety and reduce medical error, especially since teams make fewer mistakes when every member of a team is aware of each teammate's responsibilities [3] . "
    11/2012; 3(3). DOI:10.5430/jnep.v3n3p1
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    • "When using closed-loop communication, the leader makes the team members aware of important observations by asking questions about the patient’s condition. The question is addressed to one of the team members, who then has to show that he or she is paying attention by giving feedback to the leader [2]. The leader then closes the loop by confirming that the message has been correctly understood. "
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    ABSTRACT: Background In emergency situations, it is important for the trauma team to efficiently communicate their observations and assessments. One common communication strategy is “closed-loop communication”, which can be described as a transmission model in which feedback is of great importance. The role of the leader is to create a shared goal in order to achieve consensus in the work for the safety of the patient. The purpose of this study was to analyze how formal leaders communicate knowledge, create consensus, and position themselves in relation to others in the team. Methods Sixteen trauma teams were audio- and video-recorded during high fidelity training in an emergency department. Each team consisted of six members: one surgeon or emergency physician (the designated team leader), one anaesthesiologist, one nurse anaesthetist, one enrolled nurse from the theatre ward, one registered nurse and one enrolled nurse from the emergency department (ED). The communication was transcribed and analyzed, inspired by discourse psychology and Strauss’ concept of “negotiated order”. The data were organized and coded in NVivo 9. Results The findings suggest that leaders use coercive, educational, discussing and negotiating strategies to work things through. The leaders in this study used different repertoires to convey their knowledge to the team, in order to create a common goal of the priorities of the work. Changes in repertoires were dependent on the urgency of the situation and the interaction between team members. When using these repertoires, the leaders positioned themselves in different ways, either on an authoritarian or a more egalitarian level. Conclusion This study indicates that communication in trauma teams is complex and consists of more than just transferring messages quickly. It also concerns what the leaders express, and even more importantly, how they speak to and involve other team members.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 07/2012; 20(1):44. DOI:10.1186/1757-7241-20-44 · 1.93 Impact Factor
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