Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study

Abstract

BackgroundIn the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment.MethodsIn the first phase of the project the anaesthetists’ non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors.ResultsThe framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (rs = 0.4, p = 0.11) or observed non-technical skills performance (rs = 0.4, p = 0.1).DiscussionThis study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance.ConclusionThe AeroNOTS framework could be used to facilitate education and training in non-technical skills for air ambulance clinicians, and further evaluation of this rating system is merited.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0216-5) contains supplementary material, which is available to authorized users.

Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence?

“… 8 9 While this system has initially been developed for anaesthetists, it is now also increasingly used in other medical subspecialties such as intensive care and prehospital emergency medicine. 10 11 …”

Cognitive skills of emergency medical services crew members: a literature review

“…The importance of developing a good awareness of a situation represents a common theme of many studies. Prehospital emergency situations, which can change very fast and at any moment, frequently require the development of situation awareness, both rapidly and on-the-spot [53], while synthesizing information about one's surroundings into a big picture/model of the situation [34,43,44,47,50,54]. Reay et al [47] highlights constructing a malleable/flexible model, determined to be continuously revised and adapted to a changing situation [59].…”

“…However, the reliability of such information may not always be accurate. Other relevant markers of gathering information are discriminating between relevant and irrelevant data, avoiding tunnel vision [54], summarizing gathered information after some intervals [35], and verifying information to increase reliability [34,44], e.g., checking verbally provided information by examination [35]. Furthermore, expertise research stresses the positive function of switching attention more between patients when more than one patient is involved [51] and spending more time looking at task-relevant areas of an accident [46].…”

Human factors enablers and barriers for successful airway management – an in‐depth interview study

“…Airway obstruction in recovery after thyroid surgery (emergency) 10 Neck fusion surgery with unexpected difficult airway (elective), participant was called for help 11 Drug confusion (anxiety drug and muscle relaxant drug) before surgery (emergency) 12 Laparoscopy, unexpected difficult airway (elective) 13 Acute epiglottitis, transferred from emergency department (emergency) 14 Acute appendectomy, unexpected difficult airway (emergency), participant was called for help 15 Angioedema, transferred from emergency department (emergency) 16 Acute appendectomy (emergency) themes were discussed in most interviews (13)(14)(15)(16), whereas barriers were only mentioned in four to eight interviews. Figure 2 presents an overview of the subcategories for the three enabler themes 'equipment location and storage', 'experience and learning' and 'teamwork and communication'.…”

“…One component of human factors, non-technical skills, has received a lot of attention in recent years [9][10][11] due to high-profile cases such as that of Elaine Bromiley [12]. Non-technical skills include interpersonal skills such as situational awareness, leadership and teamwork, but do not explicitly encompass the whole multiple-layered environment in which anaesthetic work is embedded.…”