A method for measuring threats and errors in surgery
We examined the measurement of non-technical skills for surgical teams using a framework derived from aviation. Twenty four paediatric cardiac surgical and 20 orthopaedic operations were studied by a single observer. Predefined intraoperative failures were recorded, from which it was possible to derive measures of technical errors, threats, and non-technical errors (NTEs). A second non-technical scoring (NTS) method was used which required the observer to give a score from 1 to 4 on the four dimensions of the scale for three stages of each operation. There was a significant positive relationship between NTEs and operative duration in orthopaedic surgery (p<0.01). In paediatric cardiac surgery, the ranked NTS measures correlated positively with the number of threats (p<0.005) and with operative duration (p<0.005). Non-technical skills measures (ranked NTS and NTEs) were also significantly positively correlated (p<0.01). This suggests that it is possible to evaluate non-technical skills in operating theatre teams, but further work is needed to improve the reliability and accuracy of the measurement methods.
error surgery non-technical skills safety teamwork