Training and assessment of non-technical skills in Norwegian helicopter emergency services: a cross-sectional and longitudinal study

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Abstract

Background

Deficient non-technical skills (NTS) among providers of critical care in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. A previous study indicated that physicians underwent less frequent training compared to pilots and HEMS crew members (HCM) and that all professional groups in Norwegian HEMS received limited training in how to cope with fatigue. Since then, training initiatives and a fatigue risk management project has been initiated. Our study aimed to explore if the frequency of simulation-based training and assessment of NTS in Norwegian HEMS has changed since 2011 following these measures.

Methods

A cross-sectional web-based survey from October through December 2016, of physicians, HCM and pilots from all civilian Norwegian HEMS-bases reporting the overall extent of simulation-based training and assessment of NTS.

Results

Of 214 invited, 109 responses were eligible for analysis. The frequency of simulation-based training and assessment of NTS has increased significantly for all professional groups in Norwegian HEMS, most prominently for the physicians. For all groups, the frequency of assessment is generally lower than the frequency of training.

Conclusions

Physicians in Norwegian HEMS seem to have adjusted to the NTS training culture of the other crew member groups. This might be a consequence of improved NTS training programs. The use of behavioural marker systems systematically in HEMS should be emphasized.

Electronic supplementary material

The online version of this article (10.1186/s13049-018-0583-1) contains supplementary material, which is available to authorized users.

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Most cited references 25

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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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Team-training in healthcare: a narrative synthesis of the literature

Sallie J Weaver, Sydney Dy, Michael Rosen (2014)

Background Patients are safer and receive higher quality care when providers work as a highly effective team. Investment in optimising healthcare teamwork has swelled in the last 10 years. Consequently, evidence regarding the effectiveness for these interventions has also grown rapidly. We provide an updated review concerning the current state of team-training science and practice in acute care settings. Methods A PubMed search for review articles examining team-training interventions in acute care settings published between 2000 and 2012 was conducted. Following identification of relevant reviews with searches terminating in 2008 and 2010, PubMed and PSNet were searched for additional primary studies published in 2011 and 2012. Primary outcomes included patient outcomes and quality indices. Secondary outcomes included teamwork behaviours, knowledge and attitudes. Results Both simulation and classroom-based team-training interventions can improve teamwork processes (eg, communication, coordination and cooperation), and implementation has been associated with improvements in patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviours, processes or emergent states and 10 reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity. Effects were reported across a range of clinical contexts. Larger effect sizes were reported for bundled team-training interventions that included tools and organisational changes to support sustainment and transfer of teamwork competencies into daily practice. Conclusions Overall, moderate-to-high-quality evidence suggests team-training can positively impact healthcare team processes and patient outcomes. Additionally, toolkits are available to support intervention development and implementation. Evidence suggests bundled team-training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes.

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Do team processes really have an effect on clinical performance? A systematic literature review.

J. Schmutz, T. Manser (2013)

There is a growing literature on the relationship between team processes and clinical performance. The purpose of this review is to summarize these articles and examine the impact of team process behaviours on clinical performance. We conducted a literature search in five major databases. Inclusion criteria were: English peer-reviewed papers published between January 2001 and May 2012, which showed or tried to show (i) a statistical relationship of a team process variable and clinical performance or (ii) an improvement of a performance variable through a team process intervention. Study quality was assessed using predefined quality indicators. For every study, we calculated the relevant effect sizes. We included 28 studies in the review, seven of which were intervention studies. Every study reported at least one significant relationship between team processes or an intervention and performance. Also, some non-significant effects were reported. Most of the reported effect sizes were large or medium. The study quality ranged from medium to high. The studies are highly diverse regarding the specific team process behaviours investigated and also regarding the methods used. However, they suggest that team process behaviours do influence clinical performance and that training results in increased performance. Future research should rely on existing theoretical frameworks, valid, and reliable methods to assess processes such as teamwork or coordination and focus on the development of adequate tools to assess process performance, linking them with outcomes in the clinical setting.

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Author and article information

Contributors

Kristen Rasmussen:

ORCID: http://orcid.org/0000-0002-9564-7274

kristen.rasmussen@norskluftambulanse.no

Henrik Langdalen: henrik.langdalen@uis.no

Stephen J. M. Sollid: stephen.sollid@norskluftambulanse.no

Eirik Bjorheim Abrahamsen: eirik.b.abrahamsen@uis.no

Leif Inge K. Sørskår: leif.i.sorskar@uis.no

Gunnar Tschudi Bondevik: gunnar.bondevik@uib.no

Håkon B. Abrahamsen: haakon.b.abrahamsen@gmail.com

Journal

Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med

Journal ID (iso-abbrev): Scand J Trauma Resusc Emerg Med

Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1757-7241

Publication date (Electronic): 7 January 2019

Publication date PMC-release: 7 January 2019

Publication date Collection: 2019

Volume: 27

Electronic Location Identifier: 1

Affiliations

[1 ]ISNI 0000 0001 2299 9255, GRID grid.18883.3a, Faculty of Health Sciences, , University of Stavanger, ; Stavanger, Norway

[2 ]ISNI 0000 0004 0481 3017, GRID grid.420120.5, Department of Research and Development, , Norwegian Air Ambulance Foundation, ; Oslo, Norway

[3 ]Division of Critical Care, Møre and Romsdal Hospital Trust, Ålesund, Norway

[4 ]ISNI 0000 0001 2299 9255, GRID grid.18883.3a, Department of Safety, Economics and Planning, , University of Stavanger, ; Stavanger, Norway

[5 ]ISNI 0000 0004 0627 2891, GRID grid.412835.9, Division of Prehospital Medicine, , Stavanger University Hospital, ; Stavanger, Norway

[6 ]ISNI 0000 0004 1936 7443, GRID grid.7914.b, Department of Global Public Health and Primary Care, , University of Bergen, ; Bergen, Norway

[7 ]GRID grid.426489.5, National Centre for Emergency Primary Health Care, , Uni Research Health, ; Bergen, Norway

[8 ]ISNI 0000 0004 0627 2891, GRID grid.412835.9, Department of Anaesthesiology and Intensive Care, , Stavanger University Hospital, ; Stavanger, Norway

Author information

Kristen Rasmussen http://orcid.org/0000-0002-9564-7274

Article

Publisher ID: 583

DOI: 10.1186/s13049-018-0583-1

PMC ID: 6323750

PubMed ID: 30616604

SO-VID: dc325dc5-09c2-449b-b66a-557e5cd19a9f

License:

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

Date received : 8 August 2018

Date accepted : 28 December 2018

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: air ambulances,helicopter,communication,leadership,non-technical skills,simulation-based training

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: air ambulances, helicopter, communication, leadership, non-technical skills, simulation-based training

Training and assessment of non-technical skills in Norwegian helicopter emergency services: a cross-sectional and longitudinal study

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Background

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Preventive and Emergency Medicine Insights

Most cited references 25

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

Team-training in healthcare: a narrative synthesis of the literature

Do team processes really have an effect on clinical performance? A systematic literature review.

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