Correlates of non-technical skills in surgery: a prospective study

BMJ Open. 2017 Jan 30;7(1):e014480. doi: 10.1136/bmjopen-2016-014480.

Abstract

Background: Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS.

Methods: We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores.

Results: We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed.

Conclusions: Miscommunications and interruptions impact on team NTS performance.

Keywords: NOTECHS; interruptions; miscommunications; non-technical skills; surgical team; teamwork.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Awareness
  • Communication*
  • Decision Making
  • Group Processes
  • Humans
  • Interprofessional Relations
  • Intraoperative Complications / etiology
  • Leadership
  • Medical Errors*
  • Operative Time
  • Patient Care Team / organization & administration*
  • Prospective Studies
  • Surgical Procedures, Operative*