Document Type : Original Article

Authors

1 1- PhD Candidate of Ergonomics, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran

2 Shiraz University of medical Sciences

3 Department of Operating Room, School of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Healthcare Management, School of Health Management & Information Sciences, Iran University of medical sciences, Tehran, Iran

Abstract

Background: Safe performance and patient safety are two important issues in the delivery of healthcare services. Non-technical skills are necessary for safe performance of anesthesiologists in the operating room. This study aimed to assess the anesthetists’ non-technical skills in Iranian hospitals.
Methods: This cross-sectional study was conducted on 38 anesthetists working in orthopedic surgery wards of two hospitals in 2019. The data were collected using the Anesthetist’s Non-Technical Skills (ANTS) system, which included four domains, namely task management, teamwork, situation awareness, and decision-making. The anesthetists were assessed by a trained observer via observing and recording the events during surgeries.
Results: The mean score of ANTS was 10.12±1.66 out of 16. Among the four skills, the highest and lowest mean scores were related to “task management” (2.94 out of 4) and “decision-making” (2.26 out of 4), respectively. Work experience showed a significant positive relationship with “decision-making” (p=0.008, r=0.974). However, higher education level was not associated with improved anesthesiology skills.
Conclusion: The quality of non-technical skills was below the acceptable level in the studied anesthetists. Thus, it is recommended that the anesthetists’ skills should be improved through educational and political interventions.

Keywords

1.         Gordon M, Fell CW, Box H, Farrell M, Stewart A. Learning health ‘safety’within non-technical skills interprofessional simulation education: a qualitative study. Med Educ Online. 2017;22(1):1272838.
2.         Flynn FM, Sandaker K, Ballangrud R. Aiming for excellence–A simulation-based study on adapting and testing an instrument for developing non-technical skills in Norwegian student nurse anaesthetists. Nurse Educ Pract. 2017;22:37-46.
3.         Siu J, Maran N, Paterson-Brown S. Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents. the surgeon. 2016;14(3):119-28.
4.         Gjeraa K, Spanager L, Konge L, Petersen RH, Østergaard D. Non-technical skills in minimally invasive surgery teams: a systematic review. Surg Endosc. 2016;30(12):5185-99.
5.         Uramatsu M, Fujisawa Y, Mizuno S, Souma T, Komatsubara A, Miki T. Do failures in non-technical skills contribute to fatal medical accidents in Japan? A review of the 2010–2013 national accident reports. BMJ Open. 2017;7(2):e013678.
6.         Skelton T, Nshimyumuremyi I, Mukwesi C, Whynot S, Zolpys L, Livingston P. Low-Cost simulation to teach anesthetists’ non-technical skills in Rwanda. Anesth Analg. 2016;123(2):474-80.
7.         Myers JA, Powell DM, Psirides A, Hathaway K, Aldington S, Haney MF. Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument-an observational study. Scand J Trauma Resusc Emerg Med. 2016;24(1):24.
8.         Doleman B, Blackwell J, Karangizi A, Butt W, Bhalla A, Lund JN, et al. Anaesthetists stress is induced by patient ASA grade and may impair non‐technical skills during intubation. Acta Anaesthesiol Scand. 2016;60(7):910-6.
9.         Flin R, Patey R. Non-technical skills for anaesthetists: developing and applying ANTS. Best Practice & Research Clinical Anaesthesiology. 2011;25(2):215-27.
10.       Flin R. Non-technical skills for anaesthetists, surgeons and scrub practitioners (ANTS, NOTSS and SPLINTS). The H C Found. 2013:1-9.
11.       Rutherford J, Flin R, Mitchell L. Teamwork, communication, and anaesthetic assistance in Scotland. British journal of anaesthesia. 2012;109(1):21-6.
12.       Gillespie BM, Harbeck E, Kang E, Steel C, Fairweather N, Chaboyer W. Correlates of non-technical skills in surgery: a prospective study. BMJ Open. 2017;7(1):e014480.
13.       Flin R, Patey R, Glavin R, Maran N. Anaesthetists' non-technical skills. Br J Anaesth. 2010;105(1):38-44.
14.       Bracco F, Masini M, De Tonetti G, Brogioni F, Amidani A, Monichino S, et al. Adaptation of non-technical skills behavioural markers for delivery room simulation. BMC Pregnancy Childbirth. 2017;17(1):89.
15.       Graham J, Hocking G, Giles E. Anaesthesia non-technical skills: can anaesthetists be trained to reliably use this behavioural marker system in 1 day? Br J Anaesth. 2010;104(4):440-5.
16.       Flin R, Fletcher G, Glavin R, Maran N, Patey R. Anaesthetists’ Non-Technical Skills (ANTS) System Handbook. UK: UOA. 2003.
17.       Wunder LL. Effect of a non-technical skills intervention on first-year student registered nurse anesthetists’ skills during crisis simulation. AANA J. 2016;84(1):46-51.
18.       Prattes G, Pflanzl L, Schlieber J, Stark G, Knotzer J. Effects of non-technical skills training in immedate life support courses. J Cardiothorac Vasc Anesth. 2017;31:S35-S6.
19.       kalantari r, zakerian sa, mahmodi majdabadi m, zanjirani farahani a, meshkati m, garosi e. Assessing the Teamwork among Surgical Teams of Hospitals Affiliated to Social Security Organizations in Tehran City. Journal of Hospital. 2016;15(3):21-9.
20.       Garosi E, Kalantari R, Zanjirani Farahani A, Zuaktafi M, Hosseinzadeh Roknabadi E, Bakhshi E. Concerns About Verbal Communication in the Operating Room: A Field Study. Human factors.0018720819858274.
21.       Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Anaesthetists’ Non‐Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth. 2003;90(5):580-8.
22.       Neuschwander A, Job A, Younes A, Mignon A, Delgoulet C, Cabon P, et al. Impact of sleep deprivation on anaesthesia residents’ non-technical skills: a pilot simulation-based prospective randomized trial. BJA: British Journal of Anaesthesia. 2017;119(1):125-31.
23.       Kalantari R, Farahani AZ, Garosi E, Badeli H, Jamali J. Translation and Psychometric Properties of the Persian Version of Oxford Non-technical Skills 2 System: Assessment of Surgical Teams’ Non-technical Skills in Orthopedic Surgery Wards. Archives of Bone and Joint Surgery. 2019;7(2):173.