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

Abstract

BackgroundNon-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary resuscitation (CPR) is increasingly emphasised. Nonetheless, the relationship between non-technical skills and technical performance is poorly understood. We hypothesise that non-technical skills become increasingly important under stressful conditions when individuals are distracted from their tasks, and investigated the relationship between non-technical and technical skills under control conditions and when external stressors are present.MethodsIn this simulator-based randomised cross-over study, 30 anaesthesiologists and anaesthesia residents from the VU University Medical Center, Amsterdam, the Netherlands, participated in two different CPR scenarios in random order. In one scenario, external stressors (radio noise and a distractive scripted family member) were added, while the other scenario without stressors served as control condition. Non-technical performance of the team leader and technical performance of the team were measured using the ‘Anaesthetists’ Non-technical Skill’ score and a recently developed technical skills score. Analysis of variance and Pearson correlation coefficients were used for statistical analyses.ResultsNon-technical performance declined when external stressors were present (adjusted mean difference 3.9 points, 95% CI 2.4 to 5.5 points). A significant correlation between non-technical and technical performance scores was observed when external stressors were present (r=0.67, 95% CI 0.40 to 0.83, p<0.001), while no evidence for such a relationship was observed under control conditions (r=0.15, 95% CI −0.22 to 0.49, p=0.42). This was equally true for all individual domains of the non-technical performance score (task management, team working, situation awareness, decision-making).ConclusionsDuring CPR with external stressors, the team’s technical performance is related to the non-technical skills of the team leader. This may have important implications for training of CPR teams.

Multiprofessional in situ simulation is an effective method of identifying latent patient safety threats on the gastroenterology ward

“…highlights that the ISS programme identified team working errors as one of the four latent safety threat themes. Ensuring team members understand the importance of non-technical skills in successful resuscitation is pivotal and supported by studies in other high pressured emergencies such as cardiopulmonary resuscitation 33. For existing staff to gain appreciation of this, there will need to be a change in learning culture and as such, ISS provides a useful opportunity to promote this with a trained faculty, planning and organisational support 34.…”

Performance Assessment of Emergency Teams and Communication in Trauma Care (PERFECT checklist)—Explorative analysis, development and validation of the PERFECT checklist: Part of the prospective longitudinal mixed-methods EPPTC trial

“…The relationships may be multifactorial, but with the knowledge that communication, and respectively speech, becomes shorter and monosyllable under stress [ 30 ] these categories can be indicated as surrogate parameters for stress. Stress has a relevant influence on the technical performance, but can be compensated by non-technical skills [ 33 ]. In our analysis, we interpreted the increasing number of words in the categories "big words" and "articles" as a surrogate marker, which indicates declined stress levels over the measurement times.…”

Exploring the relationship between health status and simulated patient-care scenario performance among experienced paramedics.

“…Additionally, as military, special forces or airline pilots, paramedics must be trained frequently and prepared for the "worst", in order to provide them the tools on how to deal with and cope with the physical and mental stress if these difficult situations. It has been documented, that simulation training performed in stressful conditions improved clinical performance and non-technical skills among health professional [78,79]. The second type of training that has been identified with beneficial influence is fitness training.…”