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      Observational Skill-based Clinical Assessment tool for Resuscitation (OSCAR): Development and validation

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          Abstract

          Aim

          The aim of the study reported here was to address the need to assess and train teamwork and non-technical skills in the context of Resuscitation. Specifically, we sought to develop a tool that is feasible to use and psychometrically sound to assess team behaviours during cardiac arrest resuscitation attempts.

          Methods

          To ensure validity, reliability, and feasibility, the Observational Skill based Clinical Assessment tool for Resuscitation (OSCAR) was developed in 3 phases. A review of the literature leading to initial tool development was followed by an assessment of face and content validity, and finally a thorough reliability assessment, using Cronbach's α to assess internal consistency and intraclass correlation to assess inter-rater reliability.

          Results

          OSCAR was developed methodically, and tested for face and content validity. Cronbach's α results ranged from 0.736 to 0.965 demonstrating high internal consistency, and intraclass correlation results ranged from 0.652 to 0.911, all of which are strongly significant and indicate good inter-rater reliability.

          Conclusion

          On the basis of our results, we conclude that OSCAR is psychometrically robust, scientifically sound, and clinically relevant. We have developed the Observational Skill-based Clinical Assessment tool for Resuscitation (OSCAR) for the assessment of non-technical skills in Resuscitation teams. We propose the use of this tool in simulation and real Cardiac Arrest Resuscitation attempts to assess, guide and train non-technical skills to team members, to improve patient safety and maximise the chances of successful resuscitation.

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          Most cited references17

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          The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care.

          Critically ill patients require high-intensity care and may be at especially high risk of iatrogenic injury because they are severely ill. We sought to study the incidence and nature of adverse events and serious errors in the critical care setting. We conducted a prospective 1-year observational study. Incidents were collected with use of a multifaceted approach including direct continuous observation. Two physicians independently assessed incident type, severity, and preventability as well as systems-related and individual performance failures. Academic, tertiary-care urban hospital. Medical intensive care unit and coronary care unit patients. None. The primary outcomes of interest were the incidence and rates of adverse events and serious errors per 1000 patient-days. A total of 391 patients with 420 unit admissions were studied during 1490 patient-days. We found 120 adverse events in 79 patients (20.2%), including 66 (55%) nonpreventable and 54 (45%) preventable adverse events as well as 223 serious errors. The rates per 1000 patient-days for all adverse events, preventable adverse events, and serious errors were 80.5, 36.2, and 149.7, respectively. Among adverse events, 13% (16/120) were life-threatening or fatal; and among serious errors, 11% (24/223) were potentially life-threatening. Most serious medical errors occurred during the ordering or execution of treatments, especially medications (61%; 170/277). Performance level failures were most commonly slips and lapses (53%; 148/277), rather than rule-based or knowledge-based mistakes. Adverse events and serious errors involving critically ill patients were common and often potentially life-threatening. Although many types of errors were identified, failure to carry out intended treatment correctly was the leading category.
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            Error, stress, and teamwork in medicine and aviation: cross sectional surveys.

            To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew. : Cross sectional surveys. : Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world. : 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers). : Perceptions of error, stress, and teamwork. : Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes. Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members.
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              Non-technical skills for surgeons in the operating room: a review of the literature.

              This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills. A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect. A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons. Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.
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                Author and article information

                Journal
                Resuscitation
                Resuscitation
                Resuscitation
                Elsevier/north-Holland Biomedical Press
                0300-9572
                1873-1570
                July 2011
                July 2011
                : 82
                : 7
                : 835-844
                Affiliations
                [a ]Department of Surgery & Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY, UK
                [b ]Centre for Perioperative Medicine and Critical Care Research, Department of Anaesthesia and Intensive Care, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
                [c ]Department of Resuscitation and Outreach, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
                [d ]Department of Anaesthetics, University College London Hospitals NHS Trust, 235 Euston Road, London, NW1 2BU, UK
                [e ]Clinical Safety Research Unit, Department of Surgery & Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY, UK
                Author notes
                [* ]Corresponding author. susanna.walker@ 123456imperial.ac.uk
                Article
                RESUS4698
                10.1016/j.resuscitation.2011.03.009
                3121958
                21481519
                4a4f72e8-96c4-428c-b769-96ad683e1f8d
                © 2011 Elsevier Ireland Ltd.

                This document may be redistributed and reused, subject to certain conditions.

                History
                : 25 January 2011
                : 26 February 2011
                : 5 March 2011
                Categories
                Clinical Paper

                Emergency medicine & Trauma
                resuscitation training,cardiac arrest teams,assessment tool,teamworking skills,adverse events,non-technical skills

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