A course for non technical skills improvement in the Emergency Department

People who work closely in high risk situations are likely to get in the condition of handle potential errors with serious consequences. Recent studies showed that almost 50% of medical errors are due a lack on Non Techinical Skills (NTSs). NTSs are ‘the cognitive, social and personal resource skills that complement technical skills and contribute to safe and efficient task performance (management, teamwork, situation awareness and leadership). In this regard, even in the health sector, it is increasing the need of training programs for developing NTSs in order to increase reliability and safety levels. In fact lack of NTSs is increasingly recognized as an important underlying cause of adverse events in healthcare. Until now, the medical areas that demonstrate a strong attention to these issues that are mainly surgery and anesthesia. More recently analysis of adverse events in the Emergency Department reveals that factors contributing usually relate to a lack of NTSs such situational awareness, decision making, communication and teamwork, and leadership. In order to improve task management of the Emergency Department of the Azienda Ospedaliera Universitaria Integrata in Verona (Italy), we developed a 30 hours course for improving physicians’ and nurses’ NTSs. Our experience our experience is inspired by what has been done in recent years in the aviation sector particularly the Crew Resource Management (CRM). The course, divided in three parts, involves 5 physicians and 5 nurses and active learning plays a pivotal role. In the first part the student learns the role and importance of the NTSs and their components: decision making, situation awareness, decision making, communication and team working, leadership. In this part of the course are also analyzed threats and error management. The following step is the analysis of evaluation grids in medical fields and the NOTECHS grid. In the aftermath an evaluation grid for NTSs in the emergency department is developed. The role playing with interactive simulating dummy constitutes the final part of the course. The purpose is to strengthen the assessment capacity of the learner. In fact, by the end of the course each student has to be able to evaluate NTSs of Emergency Department components in order to achieve improvement of their NTSs. In the Italian context, this type of training, is still struggling to take off. The topics related to clinical risk and, in particular, the non-technical skills continue to remain on the sidelines of the institutionalized training courses and are a benefit of a few. The importance of these components in mostly evident in emergency situations, like the Emergency Department is, with high interaction with the patient. The impact of NTSs is crucial not only for the patient – physician interaction but also in the relationships between colleagues and with others units, as they facilitate the establishment of a fluid relationship that improve operational quality and the results to be achieved. Emergency, especially in overcrowded setting, is an unforeseeable event, characterized by a strong emotional impact, and timeliness of actions for which it is essential that everyone knows who does what, how, when and why. We believe that improving NTSs is important for the specific characteristics of the Emergency Department, different from other hospital units. Health activities are not programmable in any way, but are carried out mostly justin- time mostly at the moment and respecting the needs of urgency. The emergency room personnel, in fact, work in unusual situations in which the health of the individual patient, threatened by an acute event, must be protected in a race against time and against the difficulties caused by the continuous influx of other users. The operator does not know the patient who will visit, information available are lacking or incomplete with respect to the patient's medical history. As highlighted in previous studies, the peculiar context of the emergence increases the possibility of error. Our challenge lies in the ability to identify solutions, strategies or tools that facilitate overcoming these risk factors. These solutions can be at individual level, through the adoption of techniques limiting the problems related to decision making and attention to the collection of information. The acquisition of skills related to teamwork and communication and leadership will improve the group working of the Emergency Department.