jrgHumanfactorsCRM

INTRODUCTION: A crisis team management (CTM) simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC) in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2), crisis team training (3), and TeamSTEPPs© models (4). The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers...

INTRODUCTION: Medical errors have an incidence of 9% and may lead to worse patient outcome. Teamwork training has the capacity to significantly reduce medical errors and therefore improve patient outcome. One common framework for teamwork training is crisis resource management, adapted from aviation and usually trained in simulation settings. Debriefing after simulation is thought to be crucial to learning teamwork-related concepts and behaviours but it remains unclear how best to debrief these aspects...

We sought to evaluate the validity of two non-technical skills evaluation instruments, the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and the Ottawa Global Rating Scale (GRS), to apply them to anaesthesia training. The content validity, response process, internal structure, relations with other variables and consequences were described for validity evidence. Simulated crisis management sessions were initiated during which two trained raters evaluated the performance of postgraduate first-, second- and third-year (PGY-1, PGY-2 and PGY-3) anaesthesia residents...

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Stress experienced by emergency medical providers during the resuscitation of critically ill or injured patients can cause cognitive and technical performance to deteriorate. Psychological skills training offers a reasonable and easily implemented solution to this problem. In this article, a specific set of 4 performance-enhancing psychological skills is introduced: breathe, talk, see, and focus. These skills comprise breathing techniques, positive self-talk, visualization or mental practice, and implementing a focus "trigger word...

In this paper, we explain the conceptual background to non-technical skills and show how they can influence job performance in anaesthesia. We then describe the taxonomy of anaesthetists' non-technical skills (ANTS) and related systems, such as ANTS-AP for anaesthetic practitioners. We discuss the training courses that have been designed to teach these non-technical skills, which are called crew resource management (CRM), crisis resource management (CRM) or crisis avoidance resource management (CARMA). Finally, we discuss the application of non-technical skills assessment systems...

The outcome of critical incidents in the operating theatre has been shown to be influenced by the behaviour of anaesthetic technicians (ATs) assisting anaesthetists, but the specific non-technical skills involved have not been described. We performed a review of critical incidents (n=1433) reported to the Australian Incident Monitoring System between 2002 and 2008 to identify which non-technical skills were used by ATs. The reports were assessed if they mentioned anaesthetic assistance or had the boxes ticked to identify "inadequate assistance" or "absent supervision or assistance"...

PURPOSE: We look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm. PRINCIPLE FINDINGS: Research in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance...

The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4) analysed reports of serious events arising from airway management during anaesthesia, intensive care and the emergency department. We conducted supplementary telephone interviews with 12 anaesthetists who had reported to NAP4, aiming to identify causal factors using a method based on the Human Factors Investigation Tool (HFIT). We identified contributing human factors in all cases (median [range] 4.5 [1-10] per case)...

This study tested the reliability, validity and usability of a prototype behavioural rating system for the non-technical skills of assistants working with the anaesthetist. Anaesthetic nurses and operating department practitioners (n = 48) used the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioners (ANTS-AP) system to rate the non-technical skills of anaesthetic assistants in 12 videos of simulated theatre work. Test-retest reliability was assessed with a sub-sample (n = 12). The skill categories assessed were 'situation awareness', 'teamwork and communication' and 'task management'...

Situation awareness (SA) is one of the essential non-technical skills for effective and safe practice in high-risk industries, such as healthcare; yet, there is limited research of its significance in anaesthetic practice. In this paper, we review this scant research that focuses on SA as patient monitoring alone and advocate for a more comprehensive view of SA in anaesthetic practice and training that extends beyond monitoring, namely, a distributed cognition approach. We identify further factors influencing anaesthetists' SA and provide a case that resulted in an anaesthetic fatality to illustrate the application of an alternative view of SA in anaesthesia...

This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia...