The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy.

Journal article

INTRODUCTION: 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. METHOD: 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. RESULTS: 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

Authors: Mishra, A; Catchpole, K; Dale, T; McCulloch, P

• Publication status: Published
• Journal: Surgical endoscopy
• Volume: 22
• Issue: 1
• Pages: 68-73
• Publication date: 2008-01-01
• DOI: 10.1007/s00464-007-9346-1
• EISSN: 1432-2218
• ISSN: 0930-2794
• Language: English
• Keywords: Reference Values; Statistics, Nonparametric; Patient Care Team; Reproducibility of Results; Medical Errors; Humans; Risk Factors; Sensitivity and Specificity; Male; Interprofessional Relations; Female; Clinical Competence; Treatment Outcome; Surgical Procedures, Elective; Probability; Great Britain; Cholecystectomy, Laparoscopic; Postoperative Complications; Attitude of Health Personnel; Confidence Intervals; Surgical Procedures, Minimally Invasive; Professional Competence; Gallstones