title: Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises.
abstract: BACKGROUND
  Deficiencies in non-technical skills (NTS) have been increasingly implicated in avoidable operating theatre errors. Accordingly, this study sought to characterize the impact of surgeon and anaesthetist non-technical skills on time to crisis resolution in a simulated operating theatre.
  
  
  METHODS
  Non-technical skills were assessed during 26 simulated crises (haemorrhage and airway emergency) performed by surgical teams. Teams consisted of surgeons, anaesthetists and nurses. Behaviour was assessed by four trained raters using the Non-Technical Skills for Surgeons (NOTSS) and Anaesthetists' Non-Technical Skills (ANTS) rating scales before and during the crisis phase of each scenario. The primary endpoint was time to crisis resolution; secondary endpoints included NTS scores before and during the crisis. A cross-classified linear mixed-effects model was used for the final analysis.
  
  
  RESULTS
  Thirteen different surgical teams were assessed. Higher NTS ratings resulted in significantly faster crisis resolution. For anaesthetists, every 1-point increase in ANTS score was associated with a decrease of 53·50 (95 per cent c.i. 31·13 to 75·87) s in time to crisis resolution (P < 0·001). Similarly, for surgeons, every 1-point increase in NOTSS score was associated with a decrease of 64·81 (26·01 to 103·60) s in time to crisis resolution in the haemorrhage scenario (P = 0·001); however, this did not apply to the difficult airway scenario. Non-technical skills scores were lower during the crisis phase of the scenarios than those measured before the crisis for both surgeons and anaesthetists.
  
  
  CONCLUSIONS
  A higher level of NTS of surgeons and anaesthetists led to quicker crisis resolution in a simulated operating theatre environment.
authors.affiliation: School of Public Health, Harvard University, Boston, Massachusetts, USA.|Departments of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: A G
authors.identifier: http://orcid.org/0000-0002-0543-3177
authors.initials: AG
authors.lastname: Doumouras
authors.affiliation: School of Public Health, Harvard University, Boston, Massachusetts, USA.|Departments of Surgery, Western University, London, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Hamidi
authors.affiliation: School of Public Health, Harvard University, Boston, Massachusetts, USA.|Departments of Surgery, Western University, London, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Lung
authors.affiliation: School of Public Health, Harvard University, Boston, Massachusetts, USA.|Departments of Surgery, Western University, London, Ontario, Canada.
authors.forename: C L
authors.initials: CL
authors.lastname: Tarola
authors.affiliation: Departments of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: M W
authors.initials: MW
authors.lastname: Tsao
authors.affiliation: Neil and Elise Wallace STRATUS Center for Medical Simulation and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Scott
authors.affiliation: Neil and Elise Wallace STRATUS Center for Medical Simulation and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.|and Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Smink
authors.affiliation: Neil and Elise Wallace STRATUS Center for Medical Simulation and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.|and Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Yule
mesh_terms: D000402:Airway Obstruction / Q000517:prevention & control; D000072077:Anesthetists / Q000193:education / Q000592:standards*; D001364:Awareness; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002983:Clinical Competence / Q000592:standards*; D000066491:Clinical Decision-Making; D003142:Communication; D006801:Humans; D007318:Inservice Training / Q000379:methods; D007400:Interprofessional Relations; D007857:Leadership; D000066908:Simulation Training / Q000379:methods; D066231:Surgeons / Q000193:education / Q000592:standards*