Gjeraa Kirsten, Mundt Anna S, Spanager Lene, Hansen Henrik J, Konge Lars, Petersen René H, Østergaard Doris
Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark.
Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark.
Ann Thorac Surg. 2017 Jul;104(1):329-335. doi: 10.1016/j.athoracsur.2017.03.010. Epub 2017 Jun 3.
Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy.
This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data analysis was deductive, and directed content analysis was used to code the text into the Oxford Non-Technical Skills system for evaluating operating teams' non-technical skills.
The most important non-technical skills described by the VATS teams were planning and preparation, situation awareness, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure with complementary and overlapping scopes of practice between surgical and anesthesia subteams.
This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important additions to the shared mental model construct: planning and preparation, risk assessment, and leadership. Shared mental models are crucial for patient safety because they enable VATS teams to anticipate problems through adaptive patterns of both implicit and explicit coordination.
手术室的安全取决于团队的非技术技能。与开放手术相比，非技术技能在微创手术中的重要性似乎有所不同。本研究的目的是确定在电视辅助胸腔镜手术（VATS）肺叶切除术中，团队成员认为哪些非技术技能对患者安全最为重要。
这是一项基于探索性、半结构化访谈的研究，共有来自丹麦所有四个进行VATS肺叶切除术的胸外科中心的21名参与者。数据分析采用演绎法，并使用定向内容分析法将文本编码到牛津非技术技能系统中，以评估手术团队的非技术技能。
VATS团队描述的最重要的非技术技能是计划与准备、态势感知、问题解决、领导力、风险评估和团队合作。这些非技术技能使团队能够形成共享心智模型，进而有助于他们预测下一步行动。参与者认为这很重要，因为他们将VATS肺叶切除术视为一项高风险手术，手术和麻醉子团队的实践范围相互补充且重叠。
本研究确定了六种非技术技能，它们是患者、当前状况和团队资源共享心智模型的基础。这些发现为共享心智模型结构增添了三个重要内容：计划与准备、风险评估和领导力。共享心智模型对患者安全至关重要，因为它们使VATS团队能够通过隐含和明确协调的适应性模式预测问题。
