Joey Siu1, Nikki Maran2, Simon Paterson-Brown2. 1. Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK. Electronic address: joey.siu@middlemore.co.nz. 2. Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK.
Abstract
BACKGROUND: The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. METHODS: Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. RESULTS: A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. CONCLUSION: A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room.
BACKGROUND: The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. METHODS: Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. RESULTS: A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. CONCLUSION: A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room.
Keywords:
Awareness*; Clinical competence*; Cognition*; Communication*; Curriculum*; Decision making; General surgery/education; General surgery/standards*; Humans; Interpersonal relations*; Leadership; Medical errors/trends*; Patient care team; Professional competence*; Professional practice/standards*; Psychomotor performance*; Task performance and analysis*
Authors: Yue-Yung Hu; Sarah Henrickson Parker; Stuart R Lipsitz; Alexander F Arriaga; Sarah E Peyre; Katherine A Corso; Emilie M Roth; Steven J Yule; Caprice C Greenberg Journal: J Am Coll Surg Date: 2015-10-17 Impact factor: 6.113
Authors: Ralf Krage; Laura Zwaan; Lian Tjon Soei Len; Mark W Kolenbrander; Dick van Groeningen; Stephan A Loer; Cordula Wagner; Patrick Schober Journal: Emerg Med J Date: 2017-08-26 Impact factor: 2.740