Skip to main content

Advertisement

SpringerLink
Log in

A method for measuring threats and errors in surgery

  • Original Article
  • Published:
Cognition, Technology & Work Aims and scope Submit manuscript

Abstract

We examined the measurement of non-technical skills for surgical teams using a framework derived from aviation. Twenty four paediatric cardiac surgical and 20 orthopaedic operations were studied by a single observer. Predefined intraoperative failures were recorded, from which it was possible to derive measures of technical errors, threats, and non-technical errors (NTEs). A second non-technical scoring (NTS) method was used which required the observer to give a score from 1 to 4 on the four dimensions of the scale for three stages of each operation. There was a significant positive relationship between NTEs and operative duration in orthopaedic surgery (p < 0.01). In paediatric cardiac surgery, the ranked NTS measures correlated positively with the number of threats (p < 0.005) and with operative duration (p < 0.005). Non-technical skills measures (ranked NTS and NTEs) were also significantly positively correlated (p < 0.01). This suggests that it is possible to evaluate non-technical skills in operating theatre teams, but further work is needed to improve the reliability and accuracy of the measurement methods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Andlauer E, Delsart MC (2001) Operational validation of NOTECHS. JARTEL WP4 final report. (Report no. JARTEL/SOF/WP4/D6_22.). The JAR TEL consortium, for the European Commission, DG TREN

  • Avermaete JAG, van Kruijsen EAC (1998) NOTECHS. The evaluation of non-technical skills of multi-pilot aircrew in relation to the JAR-FCL requirements. EC NOTECHS Project final, Amsterdam

  • Carthey J (2003) The role of structured observational research in health care. Qual Saf Health Care 12:13ii–16ii

    Article  Google Scholar 

  • Carthey J, de Leval MR, Wright DJ, Farewell VJ, Reason JT (2003) Behavioural markers of surgical excellence. Saf Sci 41:409–425

    Article  Google Scholar 

  • Catchpole K, Godden PJ, Giddings AEB, Hirst G, Dale T, Utley M, et al (2005) Identifying and reducing errors in the operating theatre (Report no. PS012). Patient safety research programme. Available at http://www.pcpoh.bham.ac.uk/publichealth/psrp/publications.htm

  • Catchpole KR, Giddings AE, de Leval MR, Peek GJ, Godden PJ, Utley M, et al (2006) Identification of systems failures in successful paediatric cardiac surgery. Ergonomics 49:567–588

    Article  Google Scholar 

  • Catchpole K, Giddings A, Wilkinson M, Hirst G, Dale T, De Leval M (2007) Improving patient safety by identifying latent failures in successful operations. Surgery 142(1):102–110

    Article  Google Scholar 

  • de Leval MR, Carthey J, Wright DJ, Reason JT (2000) Human factors and cardiac surgery: A multicenter study. J Thorac Cardiovasc Surg 119:661–672

    Article  Google Scholar 

  • Department of Health (2000) An organisation with a memory: report of an expert group on learning from adverse events in the NHS. HMSO, London

    Google Scholar 

  • Fischhoff B (1975) Hindsight does not equal foresight: the effect of outcome knowledge on judgement under uncertainty. J Exp Psychol Hum Percept Perform 1:288–299

    Article  Google Scholar 

  • Fletcher GCL, Flin RH, McGeorge P (2000) Review of human factors research in anaesthesia (Report no. SCPMDE Project: RDNES/991/C). Industrial Psychology Group, University of Aberdeen, Aberdeen

  • Fletcher GCL, Flin RH, Glavin RJ, Maran NJ, Patey R (2003) Anaesthetists’ non-technical skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 90:580–588

    Article  Google Scholar 

  • Fletcher GCL, Flin RH, Glavin RJ, Maran NJ, Patey R (2004) Rating non-technical skills: developing a behavioural marker system for use in anaesthesia. Cogn Technol Work 6:165–171

    Article  Google Scholar 

  • Flin RH, Fletcher GCL, McGeorge P, Sutherland A, Patey R (2003a) Anaesthetists’ attitudes to teamwork and safety. Anaesthesia 58:233–242

    Article  Google Scholar 

  • Flin RH, Martin L, Goeters K-M, Hormann J, Amalberti R, Valot C, et al (2003b) Development of the NOTECHS (non-technical skills) system for assessing pilots’ CRM skills. Hum Perform Extrem Environ 3:95–117

    Google Scholar 

  • Gaba DM, Maxwell M, DeAnda A (1987) Anesthetic mishaps: breaking the chain of accident evolution. Anesthesiology 66:670–676

    Article  Google Scholar 

  • Gaba DM, Howard SK, Flanagan B, Smith BE, Fish KJ, Botney R (1998) Assessment of clinical performance during simulated crises using both technical and behavioral ratings. Anesthesiology 89:123–147

    Article  Google Scholar 

  • Healey MA, Shackford SR, Osler TM, Rogers FB, Burns E (2002) Complications in surgical patients. Arch Surg 137:611–617

    Article  Google Scholar 

  • Healey AN, Undre S, Vincent CA (2006) Defining the technical skills of teamwork in surgery. Qual Saf Health Care 15:231–234

    Article  Google Scholar 

  • Helmreich RL (1994) Anatomy of a system accident: the crash of Avianca Flight 052. Int J Aviat Psychol 4:265–284

    Article  Google Scholar 

  • Helmreich RL (2000) On error management: lessons from aviation. Br Med J 320:781–785

    Article  Google Scholar 

  • Helmreich RL, Merritt AC (1998) Culture at work in aviation and medicine. Ashgate, Aldershot

    Google Scholar 

  • Helmreich RL, Schaefer H-G (1994) Team performance in the operating room. In: Bogner MS (ed) Human error in medicine. Laurence Erlbaum Associates, Hillsdale, pp 225–253

    Google Scholar 

  • Helmreich RL, Klinect JR, Wilhelm JA (1999) Models of threat, error, and CRM in flight operations. In: Proceedings of the tenth international symposium on aviation psychology, The Ohio State University, Columbus, pp 667–682

  • Hofer TP, Hayward RA (2002) Are bad outcomes from questionable clinical decisions preventable medical errors? A case of cascade iatrogenesis. Ann Intern Med 137:327–333

    Google Scholar 

  • Kennedy I (2001) Learning from bristol: the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995. (Report no. Command Paper: CM 5207)

  • Leape LL (1994) Error in medicine. J Am Med Assoc 272:1851–1857

    Article  Google Scholar 

  • Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, et al (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13:330–334

    Article  Google Scholar 

  • Lodge M, Fletcher GCL, Russell S, Goeters K-M, Hoermann H, Nijhuis H, et al (2001) Results of the experiment. JARTELWP3 final report. (Report no. JARTEL/BA/WP3/D5_20.). The JAR TEL consortium, for the European Commission, DG TREN

  • Mishra A, Catchpole K, Dale T, McCulloch P (2007) The influence of non-technical performance on technical performance in laparoscopic cholecystectomy. Surg Endosc (in press)

  • Moorthy K, Munz Y, Forrest D, Pandey V, Undre S, Vincent C, et al (2006) Surgical crisis management skills training and assessment: a simulation[corrected]-based approach to enhancing operating room performance. Ann Surg 244:139–147

    Article  Google Scholar 

  • Musson DM, Helmreich RL (2004) Team training and resource management in healthcare: current issues and future directions. Harvard Health Policy Rev 5:25–35

    Google Scholar 

  • Reason J (2000) Human error: models and management. Br Med J 320:768–770

    Article  Google Scholar 

  • Schaefer HG, Helmreich RL, Scheidegger D (1995) Safety in the operating theatre—part 1: interpersonal relationships and team performance. Curr Anaesth Crit Care 6:48–53

    Article  Google Scholar 

  • Sexton JB, Thomas EJ, Helmreich RL (2000) Error, stress and teamworking in aviation and medicine. BMJ 320:745–749

    Article  Google Scholar 

  • Vincent C, Neale G, Woloshynowych M (2001) Adverse events in British hospitals: preliminary retrospective record review. Br Med J 322:517–519

    Article  Google Scholar 

  • Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, et al (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237:460–469

    Article  Google Scholar 

  • Woods D, Cook RI (1999) Hindsight biases and local rationality. In: Durso FT, Nickerson RS, Schvaneveldt RW, Dumais ST, Lindsay DS, Chi MTH (eds) Handbook of applied cognition. Wiley, New York, pp 141–171

    Google Scholar 

  • Woods D, Patterson E (2004) How unexpected events produce an escalation of cognitive and coordinative demands. In: Hancock PA, Desmond PA (eds) Stress workload and fatigue. Lawrence Erlbaum, Hillsdale, pp 290–304

    Google Scholar 

  • Woolf SH, Kuzel AJ, Dovey SM, Phillips RL (2004) A string of mistakes: the importance of cascade analysis in describing, counting, and preventing medical errors. Ann Fam Med 2:317–326

    Article  Google Scholar 

  • Yule S, Flin R, Paterson-Brown S, Maran N (2006) Non-technical skills for surgeons in the operating room: a review of the literature. Surgery 139:140–149

    Article  Google Scholar 

Download references

Acknowledgements

This project was funded by the UK Department of Health Patient Safety Research Programme. We would like to extend our thanks to the patients and staff who allowed us to include them in our studies. Thanks also to Dr Paul Godden, Dr Martin Utley, and Professor Steve Gallivan, of the Clinical Operational Research Unit, University College London, for their assistance with this work. Research at the Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust benefits from research and development funding received from the NHS Executive.

Author information

Authors and Affiliations

  1. Nuffield Department of Surgery, University of Oxford, The John Radcliffe, Headington, Oxford, OX3 9DU, UK

    K. R. Catchpole

  2. Royal College of Surgeons, London, UK

    A. E. B. Giddings

  3. Atrainability Ltd., Guildford, Surrey, UK

    G. Hirst & T. Dale

  4. Glenfield Hospital, Leicester, UK

    G. J. Peek

  5. Great Ormond Street Hospital, London, UK

    M. R. de Leval

Authors
  1. K. R. Catchpole
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. E. B. Giddings
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Hirst
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Dale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. J. Peek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. R. de Leval
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. R. Catchpole.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Catchpole, K.R., Giddings, A.E.B., Hirst, G. et al. A method for measuring threats and errors in surgery. Cogn Tech Work 10, 295–304 (2008). https://doi.org/10.1007/s10111-007-0093-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10111-007-0093-9

Keywords

Search

Navigation