Use Of Non-technical Skills Research Articles

The effects of crew resource management on flight safety culture: corporate crew resource management (CRM 7.0)

Abstract The main purpose of crew resource management (CRM) is to ensure safe flights by preventing possible errors with the effective use of non-technical skills. The aim of the current study is to examine the effects of CRM on flight safety culture (FSC) with the help of the structural equation model with 451 airline pilots. As a result of the analysis, it was determined that there was a significant correlation between CRM and FSC and that CRM has a significant positive effect on FSC. It has been demonstrated that if CRM awareness and skills are used effectively, the perception of FSC will also improve. Furthermore, these findings indicate that there is a need to progress to the corporate CRM phase, i.e., CRM 7.0, to ensure that organisation-wide FSC awareness is established through CRM awareness.

Identifying positive and negative use of non-technical skills by anesthesiologists in the clinical operating room: An exploratory descriptive study

BackgroundTeamwork is a critical competency in high-risk settings like the operating room (OR). While conventional approaches focus on describing and learning from negative performance, there may be value in learning from high-performing behaviour, particularly in specialties where serious safety events are relatively rare. This study aimed to explore both the positive and negative use of non-technical skills by anesthesia practitioners in the OR and situate them within the clinical OR context. MethodsThis study employed a prospective observational design. Following research ethics approval, a sample of surgical cases in a tertiary hospital were recorded using the OR Black Box®. Data related to surgical phase timing, non-technical skills, team factors, and environmental factors were identified by analysts according to a modified Systems Engineering Initiative for Patient Safety model. We performed descriptive statistics and qualitative description of these observations. ResultsWe observed 25 surgical cases capturing 242 instances of positive non-technical skills among anesthesiologists in the operating room and 9 instances of negative demonstrations. Situational awareness was most frequently (n = 160) observed, followed by communication and teamwork skills (n = 82), and were most often demonstrated in the context of potential environmental distractions (e.g., doors opening, unnecessary interruptions). The least common category of positive non-technical skills observed was leadership (n = 3). ConclusionsOur findings show anesthesiologists are doing a lot “right” and there may be many opportunities for learning from positive practice in the clinical setting. These findings can inform future work to better understand and standardize best practices for non-technical performance in anesthesia.

Further development of crew resource management training : Needs assessment by means of teamwork-context analysis in anesthesia and intensive care teams.

BackgroundTeams in anesthesia and intensive care work as high responsibility teams (HRT). Success in this environment partly depends on the use of nontechnical skills which can be learned through simulation-based training. A teamwork context analysis could help to identify training requirements for crew resource management training.Material and methodsWe used a multicentric observational cross-sectional study design utilizing survey methodology to evaluate the teamwork context of different work environments, using the 62-item TAKAI inventory. We surveyed anesthesia and intensive care staff from nine hospitals in Germany which provide varying levels of care.ResultsIn total, 128 people (44.5% male, 53.9% female) from 9 German hospitals participated in the study. The topics “interconnectedness: departments”, “interconnectedness: information flow”, “dynamics”, “polytely”, “velocity of the team’s movement”, “velocity of system changes”, “hierarchy” and “hierarchy: leadership”, “shared task mental model”, “shared team mental model” and all aspects of the scale “adaptive behaviors” were identified as focal aspects to be implemented into Crew-Resource-Management (CRM) training for the evaluated work environments.ConclusionThe TAKAI scales meet quality criteria (Cronbach’s alpha > 0.6) and are appropriate for use in the analysis of the teamwork environment. The results indicate many similarities between the work contexts surveyed but also slight differences. TAKAI can be an additional method to design an appropriate simulation training program for HRT in anesthesia and intensive care medicine as there does not seem to be a one-size-fits-all simulation concept. For a special focus on the needs of a work context, the easy to perform TAKAI analysis in the needs analysis step is worthwhile.Supplementary InformationThe online version of this article (10.1007/s00101-022-01170-3) contains further illustrations, the questionnaires and a table of the demographic data of the participants.

Insights on Public Health Professionals Non-technical Skills in an Emergency Response (Multi-Team System) Environment.

This paper provides practitioner and academic insights into the importance of examining non-technical skills in a multiteam system emergency response. The case of public health professionals is highlighted, illustrated with unique qualitative field data which focused upon the use of non-technical skills at a meso level of analysis. Results reflected the importance of context upon the multiteam system and highlighted seven non-technical skills used by public health professionals to support an effective response. Recommendations for future research and implications for practice are noted for this hard to access professional group, located within emerging advances in the scientific inquiry of complex and increasingly evident, multi-team systems.

Effect of a multi-faceted rapid response system re-design on repeat calling of the rapid response team.

Repeat Rapid Response Team (RRT) calls are associated with increased in-hospital mortality risk and pose an organisation-level resource burden. Use of Non-Technical Skills (NTS) at calls has the potential to reduce potentially preventable repeat calling. NTS are usually improved through training, although this consumes time and financial resources. Re-designing the Rapid Response System (RRS) to promote use of NTS may provide a feasible alternative. A pre-post observational study was undertaken to assess the effect of an RRS re-design that aimed to promote use of NTS during RRT calls. The primary outcome was the proportion of admissions each month subject to repeat RRT calling, and the average number of repeat calls per admission each month was the secondary outcome of interest. Univariate and multivariable interrupted time series analyses compared outcomes between the two study phases. The proportion of admissions with repeat calls each month increased across both phases of the study period, but the increase was lower in the post re-design phase (change in regression slope -0.12 (standard error 0.07) post versus pre re-design). The multivariable model predicted a 6% reduction (95% confidence interval -15.1-3.1; P = 0.19) in the proportion of admissions having repeat calls at the end of the post redesign phase study compared to the predicted proportion in the absence of the re-design. The average number of calls per admission was also predicted to decrease in the post re-design phase, with an estimated difference of -0.07 calls per admission (equivalent to one fewer repeat call per 14 patients who had RRT calls) at the end of the post re-design phase (95% confidence interval -0.23-0.08, P = 0.35). This study of an RRS re-design showed modest, but not statistically significant, reductions in the proportion of admissions with repeat calls and the mean number of repeat calls per admission. Given the economic and workforce capacity issues that all health care systems now face, even small improvements in the RRS may have lasting impact across the organisation. For the potential interest of RRS managers, this paper presents a pragmatic, low-cost initiative intended to enhance communication and cooperation at RRT calls.

Reviewing Non-Technical Skills & Organizational Learning: A Comparative Analysis of Critical Safety Factors within the UK’s High-Risk Industries

Accidents in high-tech organisations are often triggered by a concatenation of human and system anomalies and errors, proving destructive to life, property and the environment. Urgent attention is required to minimize such events by training workers in high-risk organisations and ensuring adequate levels of Non-Technical Skills (NTS) training to counter related risks within the spectrum of their daily tasks. Organisational learning becomes equally relevant when industries are inclined towards becoming learning organisations by encouraging and promoting learning to manage safety. A comparative assessment is drawn by examining current practices in aviation and in the oil and gas sectors. The online survey was used to gather primary data, as well as interviewing 15 safety experts across the three sectors and another 15 safety experts recruited as focus groups to establish if NTS and organisational learning are used in safety management. Our sample comprised health and safety experts from the nuclear (n = 124, 54%), aviation (n = 59, 25%), and oil and gas sectors (n = 49, 21%). Findings revealed that the nuclear sector has not fully and officially acknowledged the use of NTS to train workers. The nuclear sector should look inwardly at how safety is managed since there is limited evidence of formal knowledge or techniques for transferring lessons to staff on NTS, which has proven to be a major critical “ingredient” in safety management in high-risk organisations.

Comprehensive Literature Search to Identify Assessment Tools for Operating Room Nontechnical Skills to Determine Common Critical Components.

Effective use of nontechnical skills (NTS) contributes to the provision of safe, quality care in the fast-paced, dynamic setting of the operating room (OR). Inter-professional education of NTS to OR team members can improve performance. Such training requires the accurate measurement of NTS in order to identify gaps in their utilization by OR teams. Although several instruments for measuring OR NTS exist in the literature, each tool tends to define specific NTS differently. We aimed to determine commonalities in defined measurements among existing OR NTS tools. We undertook a comprehensive literature review of assessment tools for OR NTS to determine the critical components common to these instruments. A PubMed search of the literature from May 2009 to May 2019 combined various combinations of keywords and Medical Subject Headings (MeSH) related to the following subjects: teamwork, teams, assessment, debriefing, surgery, operating room, nontechnical, communication. From this start, articles were selected describing specific instruments. Three reviewers then identified the common components measured among these assessment tools. Reviewers collated kin constructs within each instrument using frequency counts of similarly termed and conceptualized components. The initial PubMed search produced 119 articles of which 24 articles satisfied the inclusion criteria. Within these articles, 10 assessment tools evaluated OR NTS. Kin constructs were grouped into six NTS categories in the following decreasing frequency order: communication, situation awareness, teamwork, leadership, decision making, andtask management/decision making (equal). NTS OR assessment tools in the literature have a variety of kin constructs related to the specific measured components within the instruments. Such kin constructs contain thematic cohesion across six primary NTS groupings with some variation in scale and scope. Future plans include using this information to develop an easy-to-use assessment tool to assist with debriefing in the clinical environment.

Re-designing a rapid response system: effect on staff experiences and perceptions of rapid response team calls

BackgroundRapid Response Team (RRT) calls are clinical crises. Clinical and time pressures can hinder effective liaison between staff who call the RRT (‘users’) and those responding as part of the RRT (‘members’). Non-technical skills (NTS) training has been shown to improve communication and cooperation but requires time and financial resources that may not be available in acute care hospitals. Rapid Response System (RRS) re-design, aiming to promote use of NTS, may provide an alternative approach to improving interactions within RRTs and between members and users.MethodsRe-design of an existing mature RRS was undertaken in a tertiary, metropolitan hospital incorporating the addition of: 1) regular RRT meetings 2) RRT role badges and 3) a structured member-to-user patient care responsibility “hand-off” process. To compare experiences and perceptions of calls, users and members were surveyed pre and post re-design.ResultsPost re-design there were improvements in members’ understanding of RRT roles (P = 0.03) and responsibilities (P < 0.01), and recollection of introducing themselves to users (P = 0.02). For users, after the re-design, there were improvements in identification of the RRT leader (P < 0.01), and in the development of clinical plans for patients remaining on the ward at the end of an RRT call (P < 0.01). However, post-re-design, fewer users agreed that the structured hand-off was useful or that they should be involved in the process. Both members and users reported fewer experiences of conflict at RRT calls post-re-design (both P < 0.01).ConclusionThe RRS re-design yielded improvements in interactions between members in RRTs and between RRT members and users. However, some unintended consequences arose, particularly around user satisfaction with the structured hand-off. These findings suggest that refinement and improvement of the RRS is possible, but should be an ongoing iterative effort, ideally supported by staff training.Trial registrationNCT01551160. Registered: 12th March 2012.

Non-Technical Skills in Out-of-Hospital Cardiac Arrest Management: A Scoping Review

Introduction Current United Kingdom resuscitation guidance advocates the use of non-technical skills (NTS) such as teamwork, decision-making and communication for ad-hoc teams managing an out-of-hospital cardiac arrest (OHCA). It is unknown which NTS are advantageous or commonly used, or if there is supporting literature. This scoping review sought to establish a literature base and identify key NTS relevant to ad-hoc teams managing an OHCA. Methods Arksey and O'Malley's five-stage framework was used to perform a scoping review to identify relevant literature from the medical domain. Thematic analyses were used to identify relevant NTS in relation to OHCA management. Results A total of 12 articles were identified and selected for detailed analysis. The articles represented a range of study designs, with most commenting on observed simulated practice from in-hospital practice. There was a paucity of literature for NTS associated with ad-hoc OHCA teams. Three common NTS were identified: leadership, teamwork and communication, with improved team performance associated with a hands-off team leader. Barriers were also identified and included low confidence in communicating and hierarchical difficulties in resuscitation teams. Conclusion We believe this scoping review provides the first comprehensive review of its kind and identifies important knowledge gaps, NTS themes and recommendations for paramedic-led OHCA teams. Three NTS from in-hospital cardiac arrest management can be related to OHCA management, but further research is needed to identify specific NTS for ad-hoc teams managing an OHCA.

A simulação em enfermagem no desenvolvimento de competências não técnicas em contexto de emergência pré-hospitalar: Survey

Goal: To analyze the simulation contribution to the development of non-technical skills in pre-hospital emergency nurses. Method: Descriptive, analytic study using a Web questionnaire. A convenience sample was used in the central south region of Portugal made up by 52% of nurses (N = 65) working in prehospital emergency teams from three regions. The data were analyzed using the SPSS22, proceeding to a descriptive analysis of the same and subsequent analysis, using the measures of central tendency and dispersion. The study was approved by a competent Ethics Committee. Results: The simulation emerges as a strategy used in the training of these professionals both in the school and work context, being valued for the acquisition and development of non-technical skills. Nurses value the use of non-technical skills at the event and context for study, identifying them clearly and assigning them different levels of relevance. Knowledge is regarded as important resources in the process of care in complex situations for which the Debriefing, as time of simulation, is considered by nurses relevant and important for learning.

Priming healthcare students on the importance of non-technical skills in healthcare: How to set up a medical escape room game experience

Background: Non-technical skills (NTS) are essential for healthcare professionals. Earlier the students are made aware of this, the more time they have to acquire these skills. Escape rooms have been introduced in the medical literature but a detailed published manual on setting up and running such a learning modality is lacking. The purpose of this paper is to describe the use of an escape room to create learning opportunities, including detailed instructions, as well as an evaluation from two settings.Methods: A medical escape room focusing on NTS was developed and run in two different settings: a university summer school – EMSS17, and an international healthcare congress – EMS2018. Questionnaire data investigating entertainment value, self-evaluated use of NTS and ideas for further use of the escape room concept was obtained. Further, video analyses were conducted to triangulate self-rated analyses.Results: Majority of the participants found the escape room psychologically safe and enjoyable and would recommend the concept to other students and healthcare professionals. Video analyses showed the same tendencies regarding the use of NTS as reported by participants.Conclusions: This paper presents a fully applicable escape room manual, ready to implement, adapt, and modify. Evaluation data support the proof of concept.

Facilitators and barriers to the clinical application of teamwork skills taught in multidisciplinary simulated Trauma Team Training

BackgroundEfforts to improve teamwork in trauma include simulation-based team training with a non-technical skills (NTS) focus. However, there is a lack of evidence to inform the development of team training programs for maximum uptake of NTS in clinical practice. This descriptive paper aims to evaluate the extent NTS were practiced by the trauma team in a Level 1 trauma hospital after NTS training and to identify facilitators and barriers to use of NTS in clinical practice. MethodA 38-item questionnaire targeting clinicians who attended a simulation based multidisciplinary Trauma Team Training program was developed. The questionnaire was developed using the Theoretical Domains Framework, a validated tool to identify what practices need to change. It included questions on the current practice of NTS in real life trauma resuscitation. ResultsEighty six of 235 eligible participants (rate 37%) responded to the questionnaire. All relevant professions and clinical services were represented. There were 15 facilitators and 12 barriers identified. Barriers and facilitators were allocated to categories of factors known to influence trauma team practices. These were: (1) organisational factors that influence the trauma team, (2) team factors that influence teamwork and (3) cognitive factors that influence team decision making. ConclusionNTS were being used by frontline clinicians in real world trauma resuscitations to varying degrees, depending on organisational, team and cognitive facilitators and barriers. Facilitators to the implementation of NTS skills during trauma emergencies included team composition, roles and responsibilities, procedural compliance and leadership. Barriers included decision making and communication. This study described team members experience of using NTS in ‘real world trauma resuscitation’ to inform future team training interventions.

Non-technical skills in the out-of-hospital cardiac arrest: is it time for a pit stop?

Aims:To ascertain an understanding and identify if there are barriers to the use of non-technical skills (NTS) in an out-of-hospital cardiac arrest (OHCA) by student paramedics.Methods:An initial literature review was completed using online databases (Medline, PubMed, AMED, PsycINFO, PsycARTICLES, CINAHL) and MeSH terms (prehospital, paramedic, ambulance, EMS, non-technical skills, soft skills, crew resource management, team resource management, human factors). A mixed methods study using an adapted questionnaire (using existing, validated NTS questions) was applied to a convenience sample of student paramedics. Twenty-five Likert scaled closed-ended questions and three open-ended questions were asked, followed by a focus group. Pearson’s chi-squared and correlation statistical tests were used to examine differences in questionnaire answers, with thematic analysis used to analyse open-ended questions and focus group answers.Results:The literature review revealed a paucity of evidence for NTS in OHCA but did identify key NTS in the in-hospital environment: communication, leadership and situational awareness. Barriers to NTS included a lack of understanding of roles, a lack of clinical ability and poor planning. Fifty student paramedics (29 Trust employed and 21 direct entry) participated in the questionnaire, 31 male and 19 female. Most were aged 18–39 and had less than five years’ operational experience, with a mean of 8.5 OHCA attended per year (SD 8.55). Overall there was no statistical difference between students, however direct entry students were more likely to receive a briefing before attending an OHCA (p = 0.03) while Trust students were more likely to delegate during an OHCA (p = 0.001). There was an association that more staff attending an OHCA increased the use of checklists (p = 0.001), improved awareness (p = 0.006) and delegation of tasks (p = 0.01). There was a correlation between the switching of roles (p = 0.02) and increased task delegation (p = 0.05) the more OHCAs attended. There was no statistical difference found for gender or length of service. Five key themes were identified from open-question answers: teamwork (leadership and followership), situational awareness, communication, emotional intelligence and decision making. The focus group identified that students felt that leadership was not as important as teamwork or effective communication and there was confusion over what situational awareness was.Conclusion:Student paramedics are aware of NTS in the OHCA but there is a limited understanding of situational awareness and how to overcome barriers to improving NTS. The development of a behavioural marker tool to improve NTS in an OHCA would be beneficial.

Use of non-technical skills can predict medical student performance in acute care simulated scenarios

BackgroundThough the importance of physician non-technical (NT) skills for safe patient care is recognized, NT skills of medical students, our future physicians, has received little attention. This study aims to investigate the relationship of medical student NT skills and clinical performance during acute care team simulation (ACTS). MethodsForty-one medical students participated in ACTS. A nurse confederate facilitated and evaluated clinical performance. Two raters assessed participants’ NT skills using an adapted NT assessment tool and overall NT skills score was calculated. Regressions predicting clinical performance using NT constructs were conducted. ResultsOverall NT skills score significantly predicted students’ clinical performance (r2 = 0.178, p = 0.006). Four of the five individual NT constructs also significantly predicted performance: communication (r2 = 0.120, p = 0.027), situation awareness (r2 = 0.323, p < 0.001), leadership (r2 = 0.133, p = 0.019), and decision making (r2 = 0.163, p = 0.009). ConclusionsMedical student NT skills can predict clinical performance during ACTS. NT skills assessments can be used for targeted education for better feedback to students.

Factors that affect scrub practitioner non-technical skills: A literature review.

Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential for scrub practice, because they facilitate anticipation of the surgeon's requirements and promote appropriate communication behaviours. This literature review analyses the factors that may influence a scrub practitioner's use of non-technical skills during surgery. Recommendations are made that are intended to improve their use by reducing behavioural variations during surgery.

Development of an In Situ Thoracic Surgery Crisis Simulation Focused on Nontechnical Skill Training

Our vision was to develop an inexpensive training simulation in a functional operating room (in situ) that included surgical trainees and nursing and anesthesia staff to focus on effective interprofessional communication and teamwork skills. The simulation scenario revolved around an airway obstruction by residual tumor after pneumonectomy. This model included our thoracic operating room with patient status displayed by an open access vital sign simulator and a reversibly modified Laerdal airway mannequin (Shavanger, Norway). The simulation scenario was run seven times. Simulations were video recorded and scored with the use of Non-Technical Skills for Surgeons (NOTSS) and TeamSTEPPS2. Latent safety threats (LSTs) and feedback were obtained during the debriefing after the simulation. Feedback was captured with the Method Material Member Overall (MMMO) questionnaire. Several LSTs were identified, which included missing and redundant equipment and knowledge gaps in participants' roles. Consultant surgeons received a higher overall score than thoracic surgery fellows on both NOTSS (3.8 versus 3.3) and TeamSTEPPS2 (4.1 versus 3.2) evaluations, suggesting that the scenario effectively differentiated learners from experts with regards to nontechnical skills. The MMMO overall simulation experience score was 4.7 of 5, confirming a high-fidelity model and useful experiential learning model. At the Canadian Thoracic Bootcamp, the MMMO overall experience score was 4.8 of 5, further supporting this simulation as a robust model. An inexpensive in situ intraoperative crisis simulation model for thoracic surgical emergencies was created, implemented, and demonstrated to be effective as a proof of concept at identifying latent threats to patient safety and differentiating the nontechnical skills of trainees and consultant surgeons.

Development of a behaviour rating system for rural/remote pre-hospital settings

BackgroundRemote and Rural pre-hospital care practitioners manage serious illness and injury on an unplanned basis, necessitating technical and non-technical skills (NTS). However, no behaviour rating systems currently address NTS within these settings. Informed by health psychology theory, a NTS-specific behaviour rating system was developed for use within pre-hospital care training for remote and rural practitioners. MethodThe Immediate Medical Care Behaviour Rating System (IMCBRS), was informed by literature, expert advice and review and observation of an Immediate Medical Care (IMC) course. Once developed, the usability and appropriateness of the rating system was tested through observation of candidates' behaviour at IMC courses during simulated scenarios and rating their use of NTS using the IMCBRS. Results and conclusionObservation of training confirmed rating system items were demonstrated in 28–62% of scenarios, depending on context. The IMCBRS may thus be a useful addition to training for rural and practitioners.

Which non-technical skills do junior doctors require to prescribe safely? A systematic review.

Prescribing errors are a major source of avoidable morbidity and mortality. Junior doctors write most in-hospital prescriptions and are the least experienced members of the healthcare team. This puts them at high risk of error and makes them attractive targets for interventions to improve prescription safety. Error analysis has shown a background of complex environments with multiple contributory conditions. Similar conditions in other high risk industries, such as aviation, have led to an increased understanding of so-called human factors and the use of non-technical skills (NTS) training to try to reduce error. To date no research has examined the NTS required for safe prescribing. The aim of this review was to develop a prototype NTS taxonomy for safe prescribing, by junior doctors, in hospital settings. A systematic search identified 14 studies analyzing prescribing behaviours and errors by junior doctors. Framework analysis was used to extract data from the studies and identify behaviours related to categories of NTS that might be relevant to safe and effective prescribing performance by junior doctors. Categories were derived from existing literature and inductively from the data. A prototype taxonomy of relevant categories (situational awareness, decision making, communication and team working, and task management) and elements was constructed. This prototype will form the basis of future work to create a tool that can be used for training and assessment of medical students and junior doctors to reduce prescribing error in the future.

Perceptions of interactions between staff members calling, and those responding to, rapid response team activations for patient deterioration.

Objectives The aim of the present study was to investigate experiences of staff interactions and non-technical skills (NTS) at rapid response team (RRT) calls, and their association with repeat RRT calls. Methods Mixed-methods surveys were conducted of RRT members and staff who activate the RRT (RRT users) for their perceptions and attitudes regarding the use of NTS during RRT calls. Responses within the survey were recorded as Likert items, ranked data and free comments. The latter were coded into nodes relating to one of four NTS domains: leadership, communication, cooperation and planning. Results Two hundred and ninety-seven (32%) RRT users and 79 (73.8%) RRT members provided responses. Of the RRT user respondents, 76.5% had activated the RRT at some point. Deficits in NTS at RRT calls were revealed, with 36.9% of users not feeling involved during RRT calls and 24.7% of members perceiving that users were disinterested. Unresolved user clinical concerns, or persistence of RRT calling criteria, were reasons cited by 37.6% and 23%, respectively, of RRT users for reactivating an RRT to the same patient. Despite recollections of conflict at previous RRT calls, 92% of users would still reactivate the RRT. The most common theme in the free comments related to deficiencies in cooperation (52.9%), communication (28.6%) and leadership (14.3%). Conclusions This survey of RRT users and members revealed problems with RRT users' and members' interactions at the time of an RRT call. Both users and members considered NTS to be important, but lacking. These findings support NTS training for RRT members and users. What is known about the topic? Previous surveying has related experiences of criticism and conflict between clinical staff at RRT activations. This leads to reluctance to call the RRT when indicated, with risks to patient safety, especially if subsequent RRT activation is necessary. Training in NTS has improved clinician interactions in simulated emergencies, but the exact role of NTS during RRT calls has not yet been established. What does this paper add? The present survey examined experienced clinicians' perceptions of the use of NTS at RRT calls and the effect on subsequent calling. A key finding was a disparity between perceptions of how RRT members interact with those activating the RRT (RRT users) and their performance of NTS. This was reflected with unresolved RRT user clinical concern at the time of a call. In turn, this affected RRT users' attitudes and intentions to reactivate the RRT. Formal handover was considered desirable by both RRT users and members. What are the implications for practitioners? The interface between the RRT and those who call the RRT is crucial. This survey shows that RRT users desire to be included in the management of the deteriorating patient and have their concerns addressed before completion of RRT attendance. Failure to do so results in repeat activations to the same patient, with the potential for adverse patient outcomes. Training to include NTS, especially around handover, for RRT members may address this issue and should be explored further.

Exploring the relationship between anaesthesiologists’ non‐technical and technical skills

A combination of non-technical skills (NTS) and technical skills (TS) is crucial for anaesthetic patient management. However, a deeper understanding of the relationship between these two skills remains to be explored. We investigated the characteristics of trainee anaesthesiologists' NTS and TS in a simulated unexpected difficult airway management scenario. A mixed-method approach was used to explore the relationship between NTS and TS in 25 videos of 2nd year trainee anaesthesiologists managing a simulated difficult airway scenario. The videos were assessed using the customised version of the Anaesthetists' Non-Technical Skills System, ANTSdk, and an adapted TS checklist for calculating the correlation between NTS and TS. Written descriptions of the observed NTS were analysed using directed content analysis. The correlation between the NTS and the TS ratings was 0.106 (two-tailed significance of 0.613). Inter-rater reliability was substantial. Themes characterising good NTS included a systematic approach, planning and communicating decisions as well as responding to the evolving situation. A list of desirable, concrete NTS for the specific airway management situation was generated. This study illustrates that anaesthesiologist trainees' NTS and TS were not correlated in this setting, but rather intertwined and how the interplay of NTS and TS can impact patient management. Themes describing the characteristics of NTS and a list of desirable, concrete NTS were developed to aid the understanding, training and use of NTS.