Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-26T14:27:27.581Z Has data issue: false hasContentIssue false

12 - Non-technical skills and anaesthesia

Published online by Cambridge University Press:  15 December 2009

By
Rona Patey
Edited by
Jeremy Cashman  and
Michael Grounds
Rona Patey
Affiliation:
Department of Anaesthesia Aberdeen Royal Infirmary Foresterhill Aberdeen AB25 2ZN Scotland
Jeremy Cashman
Affiliation:
St George's Hospital, London
Michael Grounds
Affiliation:
St George's Hospital, London
Get access

Summary

In 2000 the UK Department of Health published a report entitled ‘An Organisation with a Memory’. This report defined an adverse health care event as ‘an event or omission arising during clinical care and causing physical or psychological injury to a patient’, and a healthcare near miss as a situation where the events/omissions or sequences of these don't develop further (owing to compensating action or good fortune). Like the earlier US Institute of Medicine report ‘To Err is Human’, this report acknowledged that it was not possible to eliminate adverse events from healthcare, but that the system should learn from past experience.

There were several recommendations designed to minimise avoidable harm to patients made in the UK report. One of these recommendations was that the experiences of other industries associated with high risk should be examined and, where appropriate, adopted by the National Health Service. The industries being referred to here have been called high-reliability organisations; that is organisations that regard safety concerns as paramount. Civil aviation, offshore oil exploration and nuclear power industries have all been categorised in this way. In these industries it has been established by means of human factors research that, rather than technical performance, human performance is highly significant in the generation and the recovery from adverse events. Human factors is the scientific discipline that is concerned with the interactions between human beings and the environment or system in which they work.

Type
Chapter
Information
Recent Advances in Anaesthesia and Intensive Care , pp. 197 - 212
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Department of Health. An Organization with a Memory. London: Department of Health, 2000.
Kohn, LT, Corrigan, JM, Donaldson, MS (eds.). To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine, 1999.Google Scholar
Helmreich, RL. On error management: lessons from aviation. BMJ 2000; 320: 781–5.CrossRefGoogle ScholarPubMed
Klampfer B, Flin R, Helmreich RL, et al. Enhancing performance in high-risk environments: Recommendations for the use of behavioural markers; www.abdn.ac.UK/iprc/papers%20reports/Ants/GIHRE21_rec_for_use_of_beh_markers.pdf
Department of Health. Building a Safer NHS for Patients: Implementing an Organisation with a Memory. London: Department of Health, 2001.
Cooper, JB, Gaba, DM. No myth: anesthesia is a model for addressing patient safety. Anesthesiology 2002; 97: 1335–7.CrossRefGoogle ScholarPubMed
Gaba, DM. Anaesthesiology as a model for patient safety in health care. BMJ 2000; 320: 785–8.CrossRefGoogle ScholarPubMed
Fletcher, GL, McGeorge, P, Flin, R, Glavin, R, Maran, N. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth 2002; 88: 418–29.CrossRefGoogle ScholarPubMed
Helmreich, RL, Merritt, AC, Wilhelm, JA. The evolution of crew resource management training in commercial aviation. Int J Aviat Psychol 1999; 9: 19–32.CrossRefGoogle ScholarPubMed
Flin, R, Goeters, K-M, Hörmann, H-J, et al. Development of the NOTECHS (non-technical skills) system for assessing pilots' CRM skills. Hum Factors Aerospace Saf 2003; 3: 95–117.Google Scholar
O'Connor, P, Hörmann, H-J, Flin, R, Lodge, M, Goeters, K-M. The JARTEL Group. Developing a method for evaluating crew resource management skills: a European perspective. Int J Aviat Psychol 2002; 12: 263–85.CrossRefGoogle Scholar
Goeters, KM. Evaluation of the effects of CRM training by the assessment of non-technical skills under LOFT. Hum Factors Aerospace Saf 2002; 2: 71–86.Google Scholar
Salas, E, Wilson, KA, Burke, CS. Does crew resource management work? An update, an extension, and some critical needs. Hum Factors 2006; 48: 392–412.CrossRefGoogle ScholarPubMed
Flin, R, O'Connor, P, Mearns, K. Crew resource management: improving team work in high-reliability industries. Team Perform Manage 2002; 8: 68–78.CrossRefGoogle Scholar
Rall, M, Gaba, DM. Patient simulators. In Miller's Anesthesia, 6th edn. Philadelphia, PA: Churchill Livingstone, 2005; pp. 3073–103.Google Scholar
Howard, SK, Gaba, DM, Fish, KJ, Yang, G, Sarnquist, FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med 1992; 63: 763–70.Google ScholarPubMed
Cooper, JB, Newbower, RS, Long, CD, McPeek, B. Preventable anesthesia mishaps: a study of human factors. Anesthesiology 1978; 49: 399–406.CrossRefGoogle ScholarPubMed
Williamson, JA, Webb, RK, Sellen, A, Runciman, WB, Walt, JH. Human failure: an analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 678–83.Google ScholarPubMed
Bogner, M, (ed.) Misadventures in Health Care. Mahwah, NJ: LEA; 2004.Google Scholar
Xiao, Y, Mackenzie, CF, the LOTAS Group. Decision making in dynamic environments: fixation errors and their causes. In Proceedings of the 39th Annual Meeting of the Human Factors and Ergonomics Society. Santa Monica, CA: Human Factors and Ergonomics Society, 1995; pp. 469–73.Google Scholar
Xiao, Y, Mackenzie, CF. Collaboration in complex medical systems. In Collaborative Crew Performance in Complex Operational Systems. NATO Human Factors and Medicine Symposium, April 20–24, 1998. Neuilly sur Seire: NATO, 1998; 4–1 to 4–10.Google Scholar
Xiao, Y, Hunter, WA, McKenzie, CF, et al. Task complexity in emergency medical care and its implications for team coordination. LOTAS group. Level-one trauma anaesthesia simulation. Hum Factors 1996; 38: 636–43.CrossRefGoogle Scholar
Xiao, Y, Mackenzie, CF, Patey, R, the LOTAS Group. Team co-ordination and breakdowns in a real-life stressful environment. In Proceedings of the Human Factors and Ergonomics Society 42nd Annual Meeting. Santa Monica, CA: Human Factors and Ergonomics Society, 1998; pp. 186–90.Google Scholar
Kyle, HT, Gaba, DM. Safe passage: using simulation to teach patient safety. Clin Teach 2005; 2: 37–41.CrossRefGoogle Scholar
Rall, M, Gaba, DM. Human performance and patient safety. In Miller's Anesthesia, 6th edn. Philadelphia, PA: Churchill Livingstone, 2005; pp. 3021–72.Google Scholar
Yee, B, Naik, VN, Joo, HS, et al. Non-technical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology 2005; 103: 241–8.CrossRefGoogle Scholar
Fletcher G, Flin R, McGeorge P. Review of Behavioural Marker Systems in Anaesthesia. Workpackage 2 Report, 2000; accessible at www.abdn.ac.uk/iprc/ANTS.
Forrest, JB, Cahalan, MK, Rehder, K. Multicenter study of general anesthesia II. Results. Anesthesiology 1990; 72: 262–8.CrossRefGoogle ScholarPubMed
Gaba, DM, Maxwell, M, DeAnda, A. Anesthetic mishaps: breaking the chain of accident evolution. Anesthesiology 1987; 66: 670–6.CrossRefGoogle ScholarPubMed
Fletcher, G, Flin, R, McGeorge, P, et al. Anaesthetists' Non-technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 2003; 90: 580–8.CrossRefGoogle ScholarPubMed
Patey R, Flin R, Fletcher G, Maran N, Glavin R. Anaesthetists' non-technical skills (ANTS). Advances in Patient Safety: From Research to Implementation. Special Edition 2004. US Agency for Healthcare Research and Quality.
Gaba, DM, Howard, SK, Flanagan, B, et al. Assessment of clinical performance during simulated crises using both technical and behavioural ratings. Anesthesiology 1998; 89: 8–18.CrossRefGoogle Scholar
Rosenstock, C, Hansen, EG, Kristensen, MS, Rasmussen, LS, Skak, C. Østergaard D. Qualitative analysis of unanticipated difficult airway management. Acta Anaesthesiol Scand 2006; 50: 290–7.CrossRefGoogle ScholarPubMed
Glavin, R, Maran, N. Integrating human factors into the medical curriculum. Med Educ (Supplement) 2003; 37: 59–64.CrossRefGoogle ScholarPubMed
Blum, RH, Raemer, DB, Carroll, JS, et al. Crisis resources management training for an anaesthesia faculty: a new approach to continuing education. Med Educ 2004; 38: 45–55.CrossRefGoogle Scholar
Hayes, D. Cascade training and teachers' professional development. Engl Lang Teach J 2000; 54: 135–45.CrossRefGoogle Scholar
Moorthy, K, Munz, Y, Adams, S, Pandey, Y, Darzi, A. A human factors analysis of technical and team skills during procedural simulations. Br J Surg 2004: 90 (Suppl. 1): 88–9.Google Scholar
Moorthy, K, Vincent, C, Darzi, A. Simulation-based training. Br Med J 2005; 330: 493–4.CrossRefGoogle ScholarPubMed
Helmreich, RL, Schaefer, H-G, Sexton, JB. Operating Room Checklist Aerospace Crew Resource Project Technical Report 95–4. Austin, TX: University of Texas, 1995.Google Scholar
Davies, J. Team communication in the operating room. Acta Anesthesiol Scand 2005; 49: 898–901.CrossRefGoogle Scholar
Yule, S, Flin, R, Paterson-Brown, S, Maran, N. Non-technical skills for surgeons in the operating room: A review of the literature. Surgery 2006; 139: 140–9.CrossRefGoogle ScholarPubMed
Yule, S, Flin, R, Paterson-Brown, S, Maran, N, Rowley, D. Development of a rating system for surgeons' non-technical skills. Med Educ 2006; 40: 1098–104.CrossRefGoogle ScholarPubMed
Reader, R, Flin, R, Lauche, K, Cuthbertson, BH. Non-technical skills in the intensive care unit. Br J Anaesth 2006; 96: 551–9.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×