Improving Intraoperative Nontechnical Skills for Surgeons

Poor communication skills among surgeons are associated with malpractice claims and complaints. These claims incur financial costs to the surgeons and the hospital. To improve communication and patient safety in the operating room, experts have developed tools to facilitate and assess intraoperative nontechnical skills. Examples include the Nontechnical Skills for Surgeons (NOTSS) and the Surgical Safety Checklist. NOTSS is a framework that assesses four domains throughout the operation: situation awareness, decision making, leadership, communication, and teamwork. Similarly, the Surgical Safety Checklist was developed to help surgical teams improve intraoperative communication during specific moments of the operation (before induction of anesthesia, before skin incision, and before the patient leaves the room). At Northwestern Medicine, the use of the surgical safety checklist is mandatory system-wide. There is limited data regarding how operating room team members use the checklist in practice (i.e., appropriate use of the checklist versus the act of just checking off the boxes), and how that use affects the operating room performance metrics (increased timely antibiotic administration, unexpected delays in the schedule, and time spent outside of the OR gathering supplies during an operation), and patient outcomes (surgical site infection, hemorrhage, Return to the operating room, Length of Stay, and case cost). NMH is not unique in this respect. Data on the association of nontechnical skills and operating room incidents, efficiency, and postoperative complications are scarce. However, contextualized nontechnical skills training programs were found to improve teamwork and communication as well as the use of the surgical safety checklist.