Non-technical skills in the intensive care unit

Abstract

In high-risk industries such as aviation, the skills not related directly to technical expertise, but crucial for maintaining safety (e.g. teamwork), have been categorized as non-technical skills. Recently, research in anaesthesia has identified and developed a taxonomy of the non-technical skills requisite for safety in the operating theatre. Although many of the principles related to performance and safety within anaesthesia are relevant to the intensive care unit (ICU), relatively little research has been done to identify the non-technical skills required for safe practice within the ICU. This review focused upon critical incident studies in the ICU, in order to examine whether the contributory factors identified as underlying the critical incidents, were associated with the skill categories (e.g. task management, teamwork, situation awareness and decision making) outlined in the Anaesthetists' Non-technical Skills (ANTS) taxonomy. We found that a large proportion of the contributory factors underlying critical incidents could be attributed to a non-technical skill category outlined in the ANTS taxonomy. This is informative both for future critical incident reporting, and also as an indication that the ANTS taxonomy may provide a good starting point for the development of a non-technical skills taxonomy for intensive care. However, the ICU presents a range of unique challenges to practitioners working within it. It is therefore necessary to conduct further non-technical skills research, using human factors techniques such as root-cause analyses, observation of behaviour, attitudinal surveys, studies of cognition, and structured interviews to develop a better understanding of the non-technical skills important for safety within the ICU. Examples of such research highlight the utility of these techniques.

Beyond the Team

“…Teamwork is central to these interventions, and is described as involving collaborative decision-making, team coordination, team communication, trust, and a lack of conflict (15)(16)(17)(18)(19)(20). Furthermore, most interventions assume that different professionals work together as a team.…”

A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

“…Development and use of a taxonomy allows exemplars of behaviour and communication to be identified which in turn permits their evaluation [29,30]. We required that the taxonomy be inclusive, flexible and suitable for use in both describing and developing explanations for different clinical settings.…”

Simulation-based medical education in clinical skills laboratory

“…Technical skill is defined by as an individual skill that is required for the accomplishment of a specific task such as a diagnostic or (18). Full-environment simulation, for example, an emergency, is designed to reproduce realistic settings based on a clinical scenario using high-fidelity mannequin simulators, SPs, and replicated equipment and supplies (Figure 2A).…”