A method for measuring threats and errors in surgery

Catchpole, Ken; Giddings, A. E. B.; Hirst, Guy; Dale, Trevor; Peek, Giles J.; Leval, Marc R. de

doi:10.1007/s10111-007-0093-9

Cited by 38 publications

(33 citation statements)

References 25 publications

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“…Following usual practice,20 a task analysis defined the domain in which the scale would be used, and consultation took place with content experts (two cardiac surgeons, one vascular surgeon, one orthopaedic surgeon, two anaesthetists, one human-factors expert and two aviation-crew resource-management trainers) to confirm the scoring system and translate skills from aviation to the operating-theatre context. The resultant NOTECHS scale for use in surgery (table 1), was found to be useful in early studies in paediatric cardiac surgery and orthopaedic surgery 16 17. In order to further examine the contribution of nursing, anaesthetic and surgical subteams to the functioning of the team, a refinement was then made which provided this extra layer of definition (table 2).…”

Section: Methodsmentioning

confidence: 99%

The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre

Mishra

Catchpole

McCulloch

2009

Quality and Safety in Health Care

313

227

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Introduction: The frequency of adverse events in the operating theatre has been linked to the quality of teamwork and communication. Developing suitable measures of teamwork may play a role in reducing errors in surgery. This study reports on the development and evaluation of a method for measuring operating-theatre teamwork quality. Methods: The Oxford Non-Technical Skills (NOTECHS) scale was developed from an aviation instrument for assessment of non-technical skills. Consultation with experts and task analysis led to modifications reflecting the complexities of the theatre teamwork, particularly the coexistence of three subteams (surgeons, anaesthetists and nurses). The scale was then evaluated using teams performing laparoscopic cholecystectomy (n = 65) before and after teamwork training. Attitudes to teamwork and surgical error rates were assessed by questionnaire and direct observation methods, and used to assess the reliability and validity of the Oxford NOTECHS scale. Results: The interobserver reliability was excellent in 24 operations independently assessed by two observers (R wg = 0.99), confirmed by a third observer in 11 cases (R wg = 0.99). Validity was demonstrated through improved scores after teamwork training (t = 23.019, p = 0.005), concurrent with improved attitudes to teamwork after training; inverse correlation between NOTECHS scores and surgical errors (r = 20.267, p = 0.046); strong inverse correlation between surgical subteam score and surgical errors (r = 20.412, n = 65, p = 0.001); and strong correlation with teamwork scores from an alternative system (n = 5, r = 0.886, p = 0.046) Conclusion: The Oxford NOTECHS scale appears to be a reliable and valid instrument for assessing teamwork in the operating theatre, and is ready for further application.Within hospitals, the operating theatre is reportedly the most common site for adverse events to occur, 1 probably because it represents a complex environment where technology, competence and resources require coordination under time pressure. This combination of factors has previously been identified in teams working in other complex, high-risk environments, 2 and analogies between healthcare and other industries have been frequently and plausibly made, 3-5 supported by observations of the relationship in the operating theatre between potential adverse events and deficiencies in teamwork behaviour and coordination. [6][7][8][9][10][11][12]

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Section: Methodsmentioning

confidence: 99%

The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre

Mishra

Catchpole

McCulloch

2009

Quality and Safety in Health Care

313

227

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“…Occasionally even small problems during surgery can cause harm or escalate to errors. The detected and perceived weaknesses of a surgical process can be utilized in both error prevention and efficacy promotion of surgical working methods (Catchpole et al 2008). Therefore, errors and close calls that occur in surgery can and most definitely should be elaborated and discussed for learning purposes in order to increase patient safety and the general safety culture within a hospital organization.…”

Section: Introductionmentioning

confidence: 99%

Video-assisted surgery: suggestions for failure prevention in laparoscopic cholecystectomy

2014

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“…In the area of surgical safety, research is largely outcome driven and retrospective, limiting our understanding of structure and process variables that affect patient outcomes. To understand these variables in the cardiovascular operating room (COR), we must broaden our research methods and conduct prospective studies, including observational field studies 9 10…”

Section: Introductionmentioning

confidence: 99%

Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study

Gürses¹,

et al. 2012

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Background: Cardiac surgery is a complex, high-risk procedure with potential vulnerabilities for patient safety. The evidence base describing safety hazards in the cardiovascular operating room is underdeveloped but is essential to guide future safety improvement efforts. Objective: To identify and categorise hazards (anything that has the potential to cause a preventable adverse patient safety event) in the cardiovascular operating room. Methods: An interdisciplinary team of researchers used prospective methods, including direct observations, contextual inquiry and photographs to collect hazard data pertaining to the cardiac surgery perioperative period, which started immediately before the patient was transferred to the operating room and ended immediately after patient handoff to the postanaesthesia/intensive care unit. Data were collected between February and September 2008 in five hospitals. An interdisciplinary approach that included a human factors and systems engineering framework was used to guide the study. Results: Twenty cardiac surgeries including the corresponding handoff processes from operating room to post-anaesthesia/intensive care unit were observed. A total of 58 categories of hazards related to care providers (eg, practice variations), tasks (eg, high workload), tools and technologies (eg, poor usability), physical environment (eg, cluttered workspace), organisation (eg, hierarchical culture) and processes (eg, non-compliance with guidelines) were identified. Discussion: Hazards in cardiac surgery services are ubiquitous, indicating numerous opportunities to improve safety. Future efforts should focus on creating a stronger culture of safety in the cardiovascular operating room, increasing compliance with evidencebased infection control practices, improving communication and teamwork, and developing

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A method for measuring threats and errors in surgery

Cited by 38 publications

References 25 publications

The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre

The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre

Video-assisted surgery: suggestions for failure prevention in laparoscopic cholecystectomy

Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study

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