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.

  • Source
    [Show abstract] [Hide abstract]
    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; DOI:10.1016/j.ienj.2012.07.005 · 0.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Surgical patients are at risk of avoidable damage. A ‘time out procedure’ plus debriefing (TOPplus) to check relevant operative items systematically with all team members was designed for five Dutch hospitals in order to reduce avoidable damage during and after a surgical procedure. The overall aim of this study was to evaluate if participatory design (PD) was an appropriate method for designing TOPplus. The study consisted of two parts: 1 designing TOPplus by means of PD 2 testing the design’s content and usability. Design of TOPplus with a multidisciplinary design-expert-team and adapting it to its local context with the hospital-expert-teams proved to be valuable, fast and easy. In most hospitals, PD reduced the resistance to change and PD was effective in engaging the hospital-expert-team. In order to design product and processes for healthcare that meet the users’ specific needs it is recommended to include more users from the different system levels and allow more time and more moments for contextualisation.
    J of Design Research 01/2011; 9(3):220-240.
  • Source
    International Conference on Healthcare Systems, Ergonomics and Patient Safety (HEPS); 06/2008