Nontechnical skills performance and care processes in the management of the acute trauma patient.
BACKGROUND
Acute trauma management is a complex process, with the effective cooperation among multiple clinicians critical to success. Despite this, the effect of nontechnical skills on performance on outcomes has not been investigated previously in trauma.


METHODS
Trauma calls in an urban, level 1 trauma center were observed directly. Nontechnical performance was measured using T-NOTECHS. Times to disposition and completion of assessment care processes were recorded, as well as any delays or errors. Statistical analysis assessed the effect of T-NOTECHS on performance and outcomes, accounting for Injury Severity Scores (ISS) and time of day as potential confounding factors. Meta-analysis was performed for incidence of delays.


RESULTS
Fifty trauma calls were observed, with an ISS of 13 (interquartile range [IQR], 5-25); duration of stay 1 (IQR, 1-8) days; T-NOTECHS, 20.5 (IQR, 18-23); time to disposition, 24 minutes (IQR, 18-42). Trauma calls with low T-NOTECHS scores had a greater time to disposition: 35 minutes (IQR, 23-53) versus 20 (IQR, 16-25; P = .046). ISS showed a significant correlation to duration of stay (r = 0.736; P < .001), but not to T-NOTECHS (r = 0.201; P = .219) or time to disposition (r = 0.113; P = .494). There was no difference between "in-hours" and "out-of-hours" trauma calls for T-NOTECHS scores (21 [IQR, 18-22] vs 20 [IQR, 20-23]; P = .361), or time to disposition (34 minutes [IQR, 24-52] vs 17 [IQR, 15-27]; P = .419). Regression analysis revealed T-NOTECHS as the only factor associated with delays (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.06-0.95).


CONCLUSIONS
Better teamwork and nontechnical performance are associated with significant decreases in disposition time, an important marker of quality in acute trauma care. Addressing team and nontechnical skills has the potential to improve patient assessment, treatment, and outcomes.
Department of Surgery and Cancer, Imperial College London, London, UK. Electronic address: p.pucher@imperial.ac.uk.
Philip H
PH
Pucher
Department of Surgery and Cancer, Imperial College London, London, UK; Department of Gastrointestinal Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Rajesh
R
Aggarwal
St Mary's Hospital Major Trauma Centre, Imperial College London, London, UK.
Nicola
N
Batrick
St Mary's Hospital Major Trauma Centre, Imperial College London, London, UK; Regional Vascular Unit, St Mary's Hospital, Imperial College London, London, UK.
Michael
M
Jenkins
Department of Surgery and Cancer, Imperial College London, London, UK.
Ara
A
Darzi
D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000592:standards; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*