Rachel Davis

Reliability of a revised NOTECHS scale for use in surgical teams

BACKGROUND Recent developments in the surgical literature highlight the need for assessment of nontechnical skills in surgery. We report a revision of the NOn-TECHnical Skills (NOTECHS) scale of the aviation industry for use in surgery and detailed analysis on its reliability. METHODS The original NOTECHS scale assesses (1) Cooperation, (2) Leadership and Managerial Skills, (3) Situation Awareness and Vigilance, and (4) Decision Making. We added a Communication and Interaction dimension and adapted all subscales for use in surgical context. Reliability was assessed in simulation-based training for trainee clinicians. RESULTS Satisfactory reliability (Cronbachs alpha) was obtained (1) across professional groups and trainers and trainees, (2) in separate analyses for trainers and trainees, (3) in successive administrations of the scale, and (4) in surgical, anaesthetic and nursing groups analyzed separately. In the operating department practitioners group, Situation Awareness and Vigilance and Cooperation and Team Skills exhibited lower reliability. CONCLUSIONS Assessment of surgical nontechnical skills is becoming a training priority. The present evidence suggests that the revised NOTECHS scale exhibits good reliability. Further empirical research should assess the validity of the scale.

Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies.

Medical Education 2010: 44: 749–764

Surgical adverse events: a systematic review

BACKGROUND The aim of this systematic review is to quantify potentially preventable patient harm from the frequency, severity, and preventability of the consequences and causes of surgical adverse events to help target patient safety improvement efforts. DATA SOURCES Two authors independently reviewed articles retrieved from systematic searches of the Cochrane library, MEDLINE, Embase, PsycINFO, and Cumulative Index to Nursing & Allied Health Literature databases for inclusion and exclusion criteria, methodology, and end points. All retrospective record review studies of adverse events were included. The primary end point was the frequency of general surgery adverse events. The secondary end points were the severity and preventability of consequences and causes. CONCLUSIONS Fourteen record review studies incorporating 16,424 surgical patients were included. Adverse events occurred in 14.4% of patients (interquartile range [IQR], 12.5% to 20.1%), and potentially preventable adverse events occurred in 5.2% (IQR, 4.2% to 7.0%). The consequences of 3.6% of adverse events (IQR, 3.1% to 4.4%) were fatal, those of 10.4% (IQR, 8.5% to 12.3%) were severe, those of 34.2% (IQR, 29.2% to 39.2%) were moderate, and those of 52.5% (IQR, 49.8% to 55.3%) were minor. Errors in nonoperative management caused more frequent adverse events than errors in surgical technique.

An Examination of Opportunities for the Active Patient in Improving Patient Safety

Background Patients can make valuable contributions to their health care safety. Little is known, however, about the factors that could affect patient participation in safety-related aspects of their health care management. Examining and understanding how patient involvement in safety-related behaviors can be conceptualized will allow greater insight into why patients may be more willing to participate in some behaviors more than others may. Objective This study aimed to develop a new approach for understanding and conceptualizing patient involvement in safety with specific reference to a surgical patient cohort. Methods The authors conducted a review of the key opportunities for patient involvement along the surgical care trajectory and examination and identification of the properties and characteristics of different safety-related behaviors and the barriers to patient involvement they entail. Results Safety-related behaviors comprise 3 main properties including the type of error the behavior is trying to prevent (e.g., medication error), the action required by the patient (e.g., asking questions), and the characteristics of the action (e.g., whether the behavior involves interacting with a health care professional). Barriers to patient involvement that relate to patients and health care professionals can be broadly categorized as interpersonal, intrapersonal, and cultural. Conclusions We believe that thinking of patient involvement in safety relating to properties and characteristics of the behavior together with the barriers to involvement could aid the design, implementation, and evaluation of interventions aimed at encouraging patient participation. It will also enable a greater understanding and assessment of not only what interventions may be effective (at encouraging patient involvement) but when they might be effective (i.e., what stage of the care pathway) and why.

Patient involvement in patient safety: the health-care professional's perspective.

Background Despite increasing recognition that patients could play an important role in promoting the safety of their care, little is known on this issue regarding health-care professionals’ (HCPs’) attitudes toward patient involvement. Objectives To investigate physicians’ and nurses’ attitudes toward patient involvement in safety-related behaviors, both through their eyes as a health-care professional and as a potential patient. Design Cross-sectional exploratory study using 2 surveys. Survey 1 addressed HCPs’ attitudes toward supporting patient participation in safety-related behaviors. Survey 2 addressed HCPs’ reported willingness to participate in safety-related behaviors (as a patient). Participants Eighty health-care professionals (40 physicians and 40 nurses) from an inner city London teaching hospital. Findings Attitudes were affected by the type of behavior, who the HCP is interacting with, and the participants own professional role. Overall, both professions held positive attitudes toward patient involvement, although in general, nurses versus physicians were more willing to both support patient involvement and participate themselves as a patient. Conclusion Compared with other research on “lay” patients’ attitudes, our data suggest that when HCPs are patients in hospital, they may be more willing to participate in safety-related behaviors. Promisingly, our data also suggest HCPs are willing to support patient involvement in safety-related behaviors, which may suggest they are happy to participate in interventions aimed at encouraging patient involvement in this area. Further in-depth research is needed to investigate the roles that HCPs (as both a patient and HCP) believe are appropriate for patients to participate in, under what circumstances and why.

Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis

Objective Surgical complications may affect patients psychologically due to challenges such as prolonged recovery or long-lasting disability. Psychological distress could further delay patients’ recovery as stress delays wound healing and compromises immunity. This review investigates whether surgical complications adversely affect patients’ postoperative well-being and the duration of this impact. Methods The primary data sources were ‘PsychINFO’, ‘EMBASE’ and ‘MEDLINE’ through OvidSP (year 2000 to May 2012). The reference lists of eligible articles were also reviewed. Studies were eligible if they measured the association of complications after major surgery from 4 surgical specialties (ie, cardiac, thoracic, gastrointestinal and vascular) with adult patients’ postoperative psychosocial outcomes using validated tools or psychological assessment. 13 605 articles were identified. 2 researchers independently extracted information from the included articles on study aims, participants’ characteristics, study design, surgical procedures, surgical complications, psychosocial outcomes and findings. The studies were synthesised narratively (ie, using text). Supplementary meta-analyses of the impact of surgical complications on psychosocial outcomes were also conducted. Results 50 studies were included in the narrative synthesis. Two-thirds of the studies found that patients who suffered surgical complications had significantly worse postoperative psychosocial outcomes even after controlling for preoperative psychosocial outcomes, clinical and demographic factors. Half of the studies with significant findings reported significant adverse effects of complications on patient psychosocial outcomes at 12 months (or more) postsurgery. 3 supplementary meta-analyses were completed, 1 on anxiety (including 2 studies) and 2 on physical and mental quality of life (including 3 studies). The latter indicated statistically significantly lower physical and mental quality of life (p<0.001) for patients who suffered surgical complications. Conclusions Surgical complications appear to be a significant and often long-term predictor of patient postoperative psychosocial outcomes. The results highlight the importance of attending to patients’ psychological needs in the aftermath of surgical complications.

Predictors of healthcare professionals’ attitudes towards family involvement in safety-relevant behaviours: a cross-sectional factorial survey study

Objectives To investigate predictors of healthcare professionals’ (HCPs) attitudes towards family involvement in safety-relevant behaviours. Design A cross-sectional fractional factorial survey that assessed HCPs’ attitudes towards family involvement in two error scenarios relating to hand hygiene and medication safety. Each survey comprised two randomised vignettes that described the potential error, how the family member communicated with the HCP about the error and how the HCP responded to the family member’s question. Setting 5 teaching hospitals in London, the Midlands and York. HCPs were approached on a range of medical and surgical wards. Participants 160 HCPs (73 doctors; 87 nurses) aged between 21 and 65 years (mean 37) 102 were female. Outcome measures HCP approval of family member’s behaviour; HCP reaction to the family member; anticipated effects on the family member–HCP relationship; HCP support for being questioned about hand hygiene/medication; affective rating responses. Results HCPs supported family members intervening (88%) but only 41% agreed this would have positive effects on the family member/HCP relationship. Across vignettes and error scenarios the strongest predictors of attitudes were how the HCP (in the scenario) responded to the family member and whether an error actually occurred. Doctors (vs nurses) provided systematically more positive affective ratings to the vignettes. Conclusions Important predictors of HCPs’ attitudes towards family members’ involvement in patient safety have been highlighted. In particular, a discouraging response from HCP’s decreased support for family members being involved and had strong perceived negative effects on the family member/HCP relationship.