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The Importance of Non-Technical Skills in the OR

Teamwork is the key to successful outcomes in cardiac surgery. The article in the August 5 issue of Circulation entitled “Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork: A Scientific Statement From the American Heart Association” attempts to address the importance of teamwork within the cardiac surgery operating room. Breakdowns in teamwork that lead to operative disruption are predictive of surgical errors.

Communication has been identified as one of the most important aspects of teamwork. Communication can be measured scientifically through a number of validated tools. Surgeons are excellent at self-assessment when it comes to technical ability, but they have much room for improvement when self-assessing non-technical ability, such as communication. The tools developed to measure communication are valuable in determining communication breakdown allowing researchers to correlate communication breakdown to outcomes.

If this is true, how can we use this information to improve our communication and patient outcome? There certainly is no doubt in my mind that the best chance of having a positive outcome following cardiac surgery is to have a good operation. There are many factors that can lead to good operation, including technical skills, judgment, and yes non-technical skills. Certainly, we all know poor technical skills when we see them, as evident in the accurate self-assessment of surgeon technical skills but we don’t always notice the poor non-technical skills as shown by the inaccurate self-assessment of surgeon non-technical skills.

Correlation does not prove cause! The correlation between poor non-technical skills and poor outcome does not mean one caused the other, but I do feel that was the assumption in the article. Any experienced cardiac surgery nurse or physician assistant knows that when things go awry, so does the fluidity of the case and even communication. None-the-less, the correlation should prompt teams to develop techniques to improve communication.

The article recommends several research proven techniques to improve communication. These include, use of checklists, briefings and debriefings, team training and simulations. There is little doubt that these things when properly and consistently followed will improve communication and save lives. The next time you are in the operating room, pay attention to the communication in the room, attempt to notice the breakdowns, and intervene to make a positive impact on your patient’s lives. You might save somebody’s life.

by Scott Yoder