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: 3.26). 02/2008; 22(1):68-73. DOI: 10.1007/s00464-007-9346-1
Source: PubMed


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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    • "They were defined for medical use by a group of UK-based Consultant Anaesthetists (Anesthesiologists ) who together analysed examples of critical incidents, and from these determined 15 skills whose absence had directly contributed to the adverse events (Fletcher et al. 2003). These non-technical skills were consistent across several examples, and have since been applied with minimal adaptation to critical incidents in surgical and intensive care unit (ICU) teams (Reader et al. 2006; Mishra et al. 2008; McCulloch et al. 2009). For the purposes of training and evaluating performance the non-technical skills are divided into Team Working (coordinating the team, exchanging information, using authority, assessing capabilities and supporting others), Task Management (planning and preparing, prioritising, providing and maintaining standards and identifying and using resources), Situation Awareness (gathering information from the environment, recognising and understanding and anticipating problems ) and Decision Making (identifying options, balancing risks and re-evaluating). "

    No preview · Article · Mar 2014 · Veterinary Anaesthesia and Analgesia
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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.
    Full-text · Article · Nov 2012 · International emergency nursing
    • "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] . "

    No preview · Article · Nov 2012
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