title: Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK. Electronic address: joey.siu@middlemore.co.nz.
authors.forename: Joey
authors.initials: J
authors.lastname: Siu
authors.affiliation: Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK.
authors.forename: Nikki
authors.initials: N
authors.lastname: Maran
authors.affiliation: Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Paterson-Brown
mesh_terms: D001364:Awareness; D002983:Clinical Competence; D003142:Communication; D006801:Humans; D007400:Interprofessional Relations; D007431:Intraoperative Complications / Q000453:epidemiology*; D007857:Leadership; D010348:Patient Care Team; D012189:Retrospective Studies; D006113:United Kingdom
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*