• Collection

    Decision Making in Anaesthesia & Critical Care

       

    Daniel Jolley.

    43 articles.

    Created July 15, 2020, last updated 20 days ago.


    Collection: 128, Score: 29, Trend score: 0, Read count: 30, Articles count: 43, Created: 2020-07-15 03:27:52 UTC. Updated: 2020-07-16 02:40:31 UTC.

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    Collected Articles

    • Clin Med Res · Dec 2015

      Review

      Understanding Decision Making in Critical Care.

      Human decision making involves the deliberate formulation of hypotheses and plans as well as the use of subconscious means of judging probability, likely outcome, and proper action. ⋯ This article provides an overview of known cognitive strategies, as well as a synthesis of their use in critical care. By understanding the ways by which humans formulate diagnoses and make critical decisions, we may be able to minimize errors in our own judgments as well as build training activities around known strengths and limitations of cognition.

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    • Anaesthesia · Nov 2015

      Editorial

      Obstetric difficult airway guidelines - decision-making in critical situations.

      no abstract available

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    • Sociol Health Illn · Jan 2014

      Decision-making and accountability: differences of distribution.

      The cognitive and individual framing of clinical decision-making has been undermined in the social sciences by attempts to reframe decision-making as being distributed. In various ways, shifts in understanding in social science research and theorising have wrested clinical decision-making away from the exclusive domain of medical practice and shared it throughout the healthcare disciplines. ⋯ In this article I illustrate this disparity by contrasting my ethnographic accounts of clinical practice with the professional codes of practice produced by the General Medical Council and the Nursing and Midwifery Council. I argue that a 'thicker' concept of accountability is needed; one that can accommodate the diffuseness of decision-making and the dependencies incurred in collaborative work.

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    • Br J Anaesth · Jan 2013

      How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills.

      Excellent anaesthetists were identified by anaesthesia nurses as being:

      1. Organised & focused: structured, responsible, and focused approach to work tasks.
      2. Good communicators: clear and informative, briefing of team about the plan before induction.
      3. Respectful of complexity: humble to the complexity of anaesthesia, admitting own fallibility.
      4. Patient-centred: personal contact with the patient before induction.
      5. Good situational awareness: fluent in practical work without losing overview.
      6. Calm and clear in critical situations, being able to change to a strong leading style.
      summary

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    • Can J Anaesth · May 1996

      Anaesthesia crisis resource management training: an intimidating concept, a rewarding experience.

      This two-part study was performed to identify and address anaesthetists' concerns regarding anaesthesia simulation and to evaluate the response of practitioners to simulation-based Anaesthesia Crisis Resource Management Training (ACRM). ⋯ Even though the majority of respondents have not been exposed to anaesthesia simulators, they appear to support their use in education strongly. Whereas substantial anxiety could delay the introduction of simulation based education, participants of ACRM workshops enjoy the courses and perceive them as very educational.

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    • Anaesth Intensive Care · Jun 2002

      Career choice influences in Australian anaesthetists.

      All female members and a randomly selected group of male members of the Australian Society of Anaesthetists (n = 488) were surveyed by questionnaire as part of a broader study of gender issues in anaesthesia. This paper reports on reasons for career choice and the importance of role models. Responses were received from 199 women and 98 men (60.9% of those surveyed), representing all States and one Territory. ⋯ Other important factors in career choice were the application of physiology and pharmacology in patient care, practical and procedural aspects of practice, and chance. A majority of women (56%) and men (55%) named specific role models who were influential and encouraging in their choice. These results are similar to those of other studies.

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    • Curr Opin Anaesthesiol · Dec 2012

      Review

      Decision-making and safety in anesthesiology.

      Anesthesiologists work in a complex environment that is intolerant of errors. Cognitive errors, or errors in thought processes, are mistakes that a clinician makes despite 'knowing better'. Several new studies provide a better understanding of how to manage risk while making better decisions. ⋯ Effective decision-making and risk management reduce the risk of adverse events in the operating room. This article proposes several new decision-making and risk assessment tools for use in the operating room.

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    • Anesthesiology · Jan 2014

      Review

      Cognitive Processes in Anesthesiology Decision-making.

      The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology. ⋯ The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame. Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making.

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    • Br J Anaesth · Jun 2009

      Multicenter Study

      Motivational influences on anaesthetists' use of practice guidelines.

      With the proliferation of practice guidelines in anaesthesia comes the possibility that anaesthetists may, during the course of their work, commit 'violations' (actions that are not intended to cause harm to patients, but that deviate from guidelines). These may have a long-term impact on patient safety, and so there is a need to understand what makes anaesthetists decide to follow or deviate from guidelines. ⋯ Anaesthetists' decisions to follow or deviate from guidelines are influenced by the beliefs they hold about the consequences of their actions, the direct or indirect influence of others, and the presence of factors that encourage or facilitate particular courses of action.

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    • Br J Anaesth · Jul 2010

      Review

      Doing a good job and getting something good out of it: on stress and well-being in anaesthesia.

      The anaesthetist's work, aimed at giving safe anaesthesia to patients, can do both harm and good to the anaesthetist. Research on stress in anaesthesia has traditionally focused on how the negative effects of stress can be avoided and much effort has been put into improving anaesthetists' work environment to reduce the level of stress. In this review, however, we give attention instead to what the individual anaesthetist can do to improve his or her well-being at work. ⋯ We describe here some lines of thought that experienced anaesthetists use to buffer the effects of work stress on physical health and mental well-being. By reframing a situation, they can reduce its stress content even if the problem at hand cannot be successfully solved. Trainee anaesthetists, who experience much stress at work and are at risk of burnout, would benefit from learning about these coping strategies.

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    • Br J Anaesth · May 2017

      Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists.

      The variability in risk tolerance in medicine is not well understood. Parallels are often drawn between aviation and anaesthesia. The aviation industry is perceived as culturally risk averse, and part of preflight checks involves a decision on whether the flight can operate. This is sometimes termed a go/no-go decision. This questionnaire study was undertaken to explore the equivalent go/no-go decision in anaesthesia. We presented anaesthetists with a range of situations in which additional risk might be expected and asked them to decide whether they would proceed with the case. ⋯ It is clear that safety decisions cannot be made in isolation and that clinicians must consider operational requirements, such as throughput, when making a go/no-go decision. The level of variability in decision-making was surprising, particularly for scenarios that appeared to go against guidelines.

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    • Br J Anaesth · Sep 2017

      Comment Letter

      Response to: Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists.

      no abstract available

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    • Br J Anaesth · Jul 2010

      Review

      Anaesthetists' non-technical skills.

      This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia.

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    • Anaesth Intensive Care · Mar 2014

      The effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing subsequent simulated 'Can't Intubate, Can't Oxygenate' scenarios.

      The decision to attempt a percutaneous airway in a recognised 'Can't Intubate, Can't Oxygenate' (CICO) situation may occur too late to avoid a poor outcome. Our study was designed to investigate the effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing CICO scenarios in subsequent simulation. Nine anaesthesia trainees from Logan Hospital participated. ⋯ The median number of deviations from the Difficult Airway Society algorithm was 0 for the simulation group compared to 1 for the non-simulation group. This small study suggests that high-fidelity simulation shortens the decision-making time of anaesthesia trainees in subsequent simulated CICO scenarios. This observation warrants follow-up in larger prospective trials.

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    • Anaesthesia · Jan 1978

      Letter

      Fatigue in the practice of anaesthesia.

      no abstract available

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    • Qual Saf Health Care · Jun 2005

      Comparative Study

      Crisis management during anaesthesia: the development of an anaesthetic crisis management manual.

      All anaesthetists have to handle life threatening crises with little or no warning. However, some cognitive strategies and work practices that are appropriate for speed and efficiency under normal circumstances may become maladaptive in a crisis. It was judged in a previous study that the use of a structured "core" algorithm (based on the mnemonic COVER ABCD-A SWIFT CHECK) would diagnose and correct the problem in 60% of cases and provide a functional diagnosis in virtually all of the remaining 40%. It was recommended that specific sub-algorithms be developed for managing the problems underlying the remaining 40% of crises and assembled in an easy-to-use manual. Sub-algorithms were therefore developed for these problems so that they could be checked for applicability and validity against the first 4000 anaesthesia incidents reported to the Australian Incident Monitoring Study (AIMS). ⋯ The 24 sub-algorithms developed form the basis for developing a rational evidence-based approach to crisis management during anaesthesia. The COVER component has been found to be satisfactory in real life resuscitation situations and the sub-algorithms have been used successfully for several years. It would now be desirable for carefully designed simulator based studies, using naive trainees at the start of their training, to systematically examine the merits and demerits of various aspects of the sub-algorithms. It would seem prudent that these sub-algorithms be regarded, for the moment, as decision aids to support and back up clinicians' natural responses to a crisis when all is not progressing as expected.

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    • Br J Anaesth · Mar 2004

      Trainee anaesthetists understand their work in different ways: implications for specialist education.

      Traditionally, programmes for specialist education in anaesthesia and intensive care have been based on lists of attributes such as skills and knowledge. However, modern research in the science of teaching has shown that competence development is linked to changes in the way professionals understand their work. The aim of this study was to define the different ways in which trainee anaesthetists understand their work. ⋯ Trainee anaesthetists understand their work in different ways. The trainee's understanding affects both his/her way of performing work tasks and how he/she develops new competences. A major task for teachers of anaesthesia is to create learning situations whereby trainees can focus on new aspects of their professional work and thus develop new ways of understanding it.

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    • Eur J Anaesthesiol · May 2013

      Influence of latent risk factors on job satisfaction, job stress and intention to leave in anaesthesia teams: a cross-sectional survey.

      Current thinking about patient safety emphasises the causal relationship between working conditions, referred to as latent risk factors (LRFs), and the quality of clinical care. ⋯ LRFs are important correlates of the well-being of anaesthesia staff. Important differences between the different members of the anaesthesia team emerged in the set of LRFs that affect their well-being. These differences should be taken into account both in research and intervention projects.

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    • Br J Anaesth · May 2003

      Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker system.

      Non-technical skills are critical for good anaesthetic practice but are not addressed explicitly in normal training. Realization of the need to train and assess these skills is growing, but these activities must be based on properly developed skills frameworks and validated measurement tools. A prototype behavioural marker system was developed using human factors research techniques. The aim of this study was to conduct an experimental evaluation to establish its basic psychometric properties and usability. ⋯ The findings of the evaluation indicated that the ANTS system has a satisfactory level of validity, reliability and usability in an experimental setting, provided users receive adequate training. It is now ready to be tested in real training environments, so that full guidelines can be developed for its integration into the anaesthetic curriculum.

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    • Anaesth Intensive Care · Oct 1995

      Decision-making in anaesthesia.

      Anaesthetists work as part of a process and deal with complex situations in their daily work. Considerable effort is put into training anaesthetists, but little has been done either in research or improving awareness of the intangible components of the anaesthesia system that affect safety, such as decision-making. The purpose of this article is to apply the principles of decision-making to anaesthesia practice.

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    • Anaesthesia · Jul 2006

      Review

      Decision analysis in anaesthesia: a tool for developing and analysing clinical management plans.

      Traditional medical decision making is unstructured and incorporates evidence haphazardly. I present a more structured approach based on decision analysis, a model that considers all relevant options and outcomes informed by evidence where appropriate. This method is useful both for planning clinical management and for analysing decisions already taken.

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    • Anaesthesia · Nov 2006

      Comment Letter

      Decision making and decision analysis.

      no abstract available

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    • Anaesthesia · Jan 2007

      Comment Letter

      Decision analysis.

      no abstract available

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    • J Gen Intern Med · May 2009

      Tips for teachers of evidence-based medicine: making sense of decision analysis using a decision tree.

      Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners understand the use and relevance of decision analysis. ⋯ Learners identified the importance of incorporating values into the decision-making process as well as the role of uncertainty. The educational objectives appeared to be reached. These teaching tips introduce clinical learners to decision analysis in a fashion aimed to illustrate principles of clinical reasoning and how patient values can be actively incorporated into complex decision making.

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    • Neurosurgery · Jan 2007

      Decision making process: problem-based decision making.

      Clinical problems are often complex. Problems of great complexity are usually associated with a commensurately greater degree of difficulty with respect to the decision making process. This is most certainly true regarding the management of cervical spondylosis. ⋯ However, more often than realized, suboptimal decisions may be made. Therefore, an assessment of the types of errors regarding clinical decision making are worthy of consideration. In this article, a scheme for decision making regarding the management of cervical spondylosis is presented.

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    • Medical hypotheses · Jun 2009

      The normalization heuristic: an untested hypothesis that may misguide medical decisions.

      Medical practice is increasingly informed by the evidence from randomized controlled trials. When such evidence is not available, clinical hypotheses based on pathophysiological reasoning and common sense guide clinical decision making. ⋯ In this paper, we operationally define this heuristic and discuss its limitations as a rule of thumb for clinical decision making. We review historical and contemporaneous examples of normalization practices as empirical evidence for the normalization heuristic and to highlight its frailty as a guide for clinical decision making.

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    • Anesthesia and analgesia · Jan 2015

      Review

      Metrology in medicine: from measurements to decision, with specific reference to anesthesia and intensive care.

      Metrology is the science of measurements. Although of critical importance in medicine and especially in critical care, frequent confusion in terms and definitions impact either interphysician communications or understanding of manufacturers' and engineers' instructions and limitations when using devices. In this review, we first list the terms defined by the International Bureau of Weights and Measures regarding quantities and units, measurements, devices for measurement, properties of measuring devices, and measurement standards. The traditional tools for assessing the most important measurement quality criteria are also reviewed with clinical examples for diagnosis, alarm, and titration purposes, as well as for assessing the uncertainty of reference methods.

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    • Can J Anaesth · Apr 1998

      Letter

      Decision-making in anaesthesia: an imbroglio of science, anecdotes and art?

      no abstract available

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    • Fam Pract Manag · May 2008

      The art and science of clinical decision making.

      no abstract available

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    • Fam Pract Manag · Jul 2008

      Comment Letter

      Another approach to clinical decision making.

      no abstract available

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    • AANA journal · Oct 2002

      A study of clinical decision making by certified registered nurse anesthetists.

      Anesthesia outcomes and related risk factors have been studied for more than 100 years. Varying sample sizes and research methods have been used, with research findings that were open to multiple interpretations. Research with closed malpractice claims demonstrates that American Society of Anesthesiologists physical status II patients undergoing elective procedures are most likely to experience damaging events intraoperatively with resultant postoperative adverse outcomes. ⋯ These files were analyzed by 10 CRNA investigators on the AANA Closed Claims research team. Variables such as inadequate preinduction activities, e.g., incomplete preanesthetic assessments, and use of cognitive biases and inaccurate probability estimation were associated with adverse outcomes in this research sample. Teaching of decision science in basic and continuing nurse anesthesia education is advocated.

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    • Am. J. Clin. Pathol. · Mar 1981

      New perspectives on the art of clinical decision making.

      no abstract available

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    • Anaesthesia · Mar 2017

      The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility.

      Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. ⋯ In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non-technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.

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    • Anaesthesia · Mar 2017

      Editorial Comment

      Helping experts and expert teams perform under duress: an agenda for cognitive aid research.

      no abstract available

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    • Anaesthesia · Aug 2017

      Comment Letter

      Cognitive aids, checklists and mental models.

      no abstract available

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    • BMC medical education · Aug 2016

      Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study.

      Patient safety depends on effective teamwork. The similarity of team members' mental models - or their shared understanding-regarding clinical tasks is likely to influence the effectiveness of teamwork. Mental models have not been measured in the complex, high-acuity environment of the operating room (OR), where professionals of different backgrounds must work together to achieve the best surgical outcome for each patient. Therefore, we aimed to explore the similarity of mental models of task sequence and of responsibility for task within multidisciplinary OR teams. ⋯ We found differences in the mental models of some OR team members about responsibility for and order of certain tasks in an emergency laparotomy. Momento is a tool that could help elucidate and better align the mental models of OR team members about surgical procedures and thereby improve teamwork and outcomes for patients.

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    • J Exp Psychol Appl · Sep 2011

      Interactions of team mental models and monitoring behaviors predict team performance in simulated anesthesia inductions.

      In the present study, we investigated how two team mental model properties (similarity vs. accuracy) and two forms of monitoring behavior (team vs. systems) interacted to predict team performance in anesthesia. In particular, we were interested in whether the relationship between monitoring behavior and team performance was moderated by team mental model properties. Thirty-one two-person teams consisting of anesthesia resident and anesthesia nurse were videotaped during a simulated anesthesia induction of general anesthesia. ⋯ When investigating the effectiveness of a specific team coordination behavior, team cognition has to be taken into account. This represents a necessary and compelling extension of the popular process-outcome relationship on which previous teamwork research in health care has focused. Moreover, the current study adds further external validity to the concept of team mental models by highlighting its usefulness in health care.

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    • Anesthesia and analgesia · Jul 2017

      Identifying Variability in Mental Models Within and Between Disciplines Caring for the Cardiac Surgical Patient.

      The cardiac operating room is a complex environment requiring efficient and effective communication between multiple disciplines. The objectives of this study were to identify and rank critical time points during the perioperative care of cardiac surgical patients, and to assess variability in responses, as a correlate of a shared mental model, regarding the importance of these time points between and within disciplines. ⋯ Cardiac surgical providers recognize distinct critical time points during cardiac surgery. However, there is a high degree of variability within and between disciplines as to the importance of these times, suggesting an absence of a shared mental model among disciplines caring for cardiac surgical patients during the perioperative period. A lack of a shared mental model could be one of the factors contributing to preventable errors in cardiac operating rooms.

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    • Ann. Thorac. Surg. · Mar 2019

      Multicenter Study Observational Study

      Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy.

      Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy. ⋯ Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.

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    • Ann. Thorac. Surg. · Jul 2017

      Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy: Team Perspectives.

      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 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.

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    • Scand J Trauma Resus · Jan 2010

      Teamwork skills, shared mental models, and performance in simulated trauma teams: an independent group design.

      Non-technical skills are seen as an important contributor to reducing adverse events and improving medical management in healthcare teams. Previous research on the effectiveness of teams has suggested that shared mental models facilitate coordination and team performance. The purpose of the study was to investigate whether demonstrated teamwork skills and behaviour indicating shared mental models would be associated with observed improved medical management in trauma team simulations. ⋯ The present study replicates and extends previous research by providing new empirical evidence of the significance of specific teamwork skills and a shared mental model for the effective medical management of trauma teams. In addition, the study underlines the generic nature of teamwork skills by demonstrating their transferability from different clinical simulations like the anaesthesia environment to trauma care, as well as the potential usefulness of behavioural frequency analysis in future research on non-technical skills.

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    • BMC anesthesiology · Dec 2019

      Impact of a semi-structured briefing on the management of adverse events in anesthesiology: a randomized pilot study.

      Human factors research has identified mental models as a key component for the effective sharing and organization of knowledge. The challenge lies in the development and application of tools that help team members to arrive at a shared understanding of a situation. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency. ⋯ Our study addresses effects on team coordination through a shared mental model as effected by a briefing prior to anesthesia induction. We found measurable improvements in airway management during those stages of the difficult airway algorithm explicitly discussed in the briefing. For those, time spent was shorter and participants were quicker to advance in the airway algorithm.

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    • Scand J Trauma Resus · Nov 2017

      High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance.

      High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral markers of shared mental models (SMM) on quality of medical management. ⋯ The results of this study emphasize the team leader's role in initiating and updating a team's shared mental model. Team leaders should also set expectations for acceptable interaction patterns (e.g., promoting information exchange) and create a team climate that encourages behaviors, such as mutual performance monitoring, backup behavior, and adaptability to enhance SMM.

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