ASSESSING TEAMS IN ENDOSCOPY: DOES GOOD NON-TECHNICAL SKILLS PERFORMANCE CORRELATE WITH GOOD CLINICAL OUTCOMES?

Abstract

Background Failures in non-technical skills (NTS) contribute to adverse events in healthcare. Previous research has explored the assessment and training of these skills, and yet there is a lack of evidence for their impact on clinical outcomes. Gastrointestinal endoscopy is a high-pressure specialty, but to date there is little on the role of NTS in this area, or a method for their assessment. This MD project aims to measure NTS in endoscopy, explore their relationship with clinical outcomes, and identify those specific to this area of healthcare. Methods An observational study of endoscopy teams in real time, using the Oxford NOTECHS II assessment tool. Comparison of NTS performance with procedure outcomes and patient satisfaction. A qualitative interview study with staff members to establish the NTS specifically relevant to working in gastrointestinal endoscopy. Results Reliability of the Oxford NOTECHS II tool by a single rater in this environment was good. Positive relationships were found between NTS scores and polyp detection, scope withdrawal time and completion of items on a safety checklist. However, relationships with other outcomes, including patient satisfaction were weak, or inconclusive. The themes identified relating to NTS in gastrointestinal endoscopy were leadership, working together as a team, situation awareness, making decisions, the patient and communication. Conclusions Although few conclusive relationships were found between NTS performance and procedure outcomes, those positive associations found seem logical as they are likely to reflect increased care and vigilance. This may have been affected by a lack of variation in scores. The NTS relevant to this area are similar to other areas of healthcare. However, the interaction with and around the awake patient is unique to endoscopy and an important influence on the NTS that staff must possess. There is scope to develop a more specific tool for the assessment of NTS in endoscopy