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

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          Abstract

          Background

          In 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.

          Methods

          In 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.

          Results

          The 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 ( r s = 0.4, p = 0.11) or observed non-technical skills performance ( r s = 0.4, p = 0.1).

          Discussion

          This 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.

          Conclusion

          The 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 material

          The online version of this article (doi:10.1186/s13049-016-0216-5) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.

          T. Manser (2009)
          This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.
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            Guidelines for the inter- and intrahospital transport of critically ill patients.

            The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. Expert opinion and a search of Index Medicus from January 1986 through October 2001 provided the basis for these guidelines. A task force of experts in the field of patient transport provided personal experience and expert opinion. Several prospective and clinical outcome studies were found. However, much of the published data comes from retrospective reviews and anecdotal reports. Experience and consensus opinion form the basis of much of these guidelines. Each hospital should have a formalized plan for intra- and interhospital transport that addresses a) pretransport coordination and communication; b) transport personnel; c) transport equipment; d) monitoring during transport; and e) documentation. The transport plan should be developed by a multidisciplinary team and should be evaluated and refined regularly using a standard quality improvement process. The transport of critically ill patients carries inherent risks. These guidelines promote measures to ensure safe patient transport. Although both intra- and interhospital transport must comply with regulations, we believe that patient safety is enhanced during transport by establishing an organized, efficient process supported by appropriate equipment and personnel.
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              Anaesthetists' non-technical skills.

              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.
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                Author and article information

                Contributors
                julie.myers@otago.ac.nz
                david.powell@otago.ac.nz
                alex.psirides@ccdhb.org.nz
                karyn.hathaway@ccdhb.org.nz
                sarah.aldington@ccdhb.org.nz
                michael.haney@anestesi.umu.se
                Journal
                Scand J Trauma Resusc Emerg Med
                Scand J Trauma Resusc Emerg Med
                Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
                BioMed Central (London )
                1757-7241
                8 March 2016
                8 March 2016
                2016
                : 24
                : 24
                Affiliations
                [ ]Occupational and Aviation Medicine Unit, University of Otago Wellington, Newtown, Wellington, 6021 New Zealand
                [ ]Department of Intensive Care Medicine, Wellington Regional Hospital, Wellington, New Zealand; University of Otago Wellington, Newtown, Wellington, 6021 New Zealand
                [ ]Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand; University of Otago Wellington, Newtown, Wellington, 6021 New Zealand
                [ ]Department of Emergency Medicine, Wellington Regional Hospital, Wellington, New Zealand
                [ ]Anesthesia and Intensive Care Medicine, Umeå University Medical Faculty, Umeå Sweden; Occupational and Aviation Medicine Unit, University of Otago Wellington, Newtown, Wellington, 6021 New Zealand
                Article
                216
                10.1186/s13049-016-0216-5
                4784461
                26955943
                09c12069-567c-46ca-8f96-491e6aa7f4e0
                © Myers et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 November 2015
                : 27 February 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100008247, University of Otago;
                Award ID: 10939901RRZ
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2016

                Emergency medicine & Trauma
                non-technical skills,air ambulance,intensive care,patient transport,clinical training

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