Enhancing Diagnostic Safety in Surgery Through Non-Technical Skills
RCSEd Communications Team
The Patient Safety Group (PSG) of the Royal College of Surgeons of Edinburgh (RCSEd) are delighted to lend our enthusiastic support to the sixth World Patient Safety Day (WPSD). This event, established by the World Health Organisation (WHO) in 2019, takes place on 17 September every year. It helps to raise global awareness amongst all stakeholders about key Patient Safety issues and foster collaboration between patients, health care workers, health care leaders and policy makers to improve patient safety. Each year a new theme is selected to highlight a priority patient safety area for action.
The theme set by the WHO for this year’s WPSD is “Improving diagnosis for patient safety”, recognising the vital importance of correct and timely diagnosis in ensuring patient safety and improving health outcomes.
In healthcare, the ability to diagnose correctly and timely is crucial for patient safety and improved health outcomes. The World Health Organisation (WHO) emphasises the need for diagnostic safety to ensure patients receive the care they need without unnecessary delays or errors. This blog highlights the importance of non-technical skills (NTS) in enhancing diagnostic safety across various healthcare settings, including operating theatres/rooms, emergency departments (A&E), clinics, and ward rounds. We will explore the Non-Technical Skills for Surgeons (NOTSS) tool which has been developed and supported by Royal College of Surgeons of Edinburgh for over 20 years, and introduce the concept of Surgical Sabermetrics, a technology-driven approach to fostering a safer diagnostic environment.
The NOTSS Tool: Enhancing Surgical Performance
The Non-Technical Skills for Surgeons (NOTSS) tool is a validated framework designed to assess and improve the non-technical skills of healthcare professionals. It focuses on four key areas:
- Situation Awareness: Gathering, interpreting, and anticipating information to foresee future states
- Decision Making: Skills for reviewing data, coming to a judgement, communication decisions, and reviewing outcomes
- Team Communication: Facilitating clear and effective exchange of information and building a shared understanding
- Leadership: Establishing and maintaining standards, providing support, and managing stress
These skills are critical in ensuring accurate and timely diagnoses by fostering an environment of collaboration, clear communication, and proactive management of clinical situations.
Situation Awareness: Staying Ahead in Diagnostics
Situation awareness involves continuously gathering information, understanding its significance, and anticipating future states. This skill is crucial for recognising early signs of deterioration or complications in patients. In the operating theatre, maintaining high situation awareness helps surgical teams anticipate and mitigate potential issues before they escalate. In A&E and clinics, it enables healthcare providers to quickly identify and respond to urgent medical conditions, improving diagnostic accuracy and patient outcomes.
Decision Making: Choosing the Best Path
Decision making is a critical component of diagnostic safety. It involves considering various diagnostic options, selecting the most appropriate one, and communicating this decision effectively to the team and the patient. Good decision making is supported by thorough situation awareness and effective communication. In the operating theatre, for example, the lead surgeon must make swift decisions about the best course of action, often under pressure. Similarly, in A&E, clinicians must rapidly decide on the most appropriate diagnostic tests and treatments for patients presenting with acute symptoms. It is important to recognise that decisions are often made based on incomplete information and that experts build memory of past experience that allows them to make fast and efficient ‘satisfactory’ decisions in high pressure environments. Like all professionals, surgical team members require cognitive load capacity in order to gather information and make decisions. Adrenaline and stress response can reduce available cognitive load which is why people can make satisfactory but perhaps not the perfect decision under pressure.
Team Communication: Enhancing Collaborative Diagnostics
Teamwork is the backbone of successful healthcare delivery. In a clinical setting, the coordinated efforts of doctors, nurses, and support staff are vital for collecting and interpreting patient data accurately. Good teamwork ensures that critical information is shared promptly and that team members support each other in making informed decisions. This collaborative approach is crucial in emergency departments, where rapid, coordinated responses are necessary to diagnose and treat patients effectively. Miscommunication can lead to missed or incorrect diagnoses, which can have severe consequences for patient safety. Effective communication also involves active listening and confirming that messages have been received and understood, thereby minimising the risk of diagnostic errors.
Leadership: Guiding Diagnostic Precision
Effective leadership is essential in all healthcare settings. Leaders set the tone for teamwork and communication, ensuring that all team members are aligned towards common goals. In the operating theatre, for example, a surgeon who demonstrates strong leadership can guide the team through complex procedures with precision, reducing the risk of diagnostic errors. Similarly, in A&E or during ward rounds, effective leadership helps prioritise tasks and manage resources efficiently, leading to quicker and more accurate diagnoses.
Surgical Sabermetrics: Data-Driven Improvement
Surgical Sabermetrics is an innovative approach that applies data analytics to improve surgical performance and outcomes. By analysing various metrics related to surgical procedures and outcomes, healthcare professionals can identify patterns and areas for improvement. Integrating the insights from Surgical Sabermetrics with the NOTSS framework allows for a comprehensive approach to enhancing both technical and non-technical skills. This data-driven strategy helps in creating more effective diagnostic pathways and supports health workers in making accurate decisions. The Surgical Sabermetrics Laboratory at Usher Institute, University of Edinburgh is developing and implementing technology to enhance surgical performance, aligned with a desired future where data-driven clinical excellence becomes the standard through technological innovation, collaborative intelligence, and application of human factors science.
Conclusion
Diagnostic safety is a cornerstone of patient safety and quality healthcare. The NOTSS tool provides a structured way to assess and improve non-technical skills, which are essential for accurate and timely diagnosis. On World Patient Safety Day, it is crucial to recognise the importance of these skills in improving diagnostic safety. By adopting a multifaceted approach that includes robust non-technical skills training and leveraging data-driven insights from Surgical Sabermetrics, healthcare systems can significantly reduce diagnostic errors and improve patient outcomes. Prioritising diagnostic safety not only ensures that patients receive the care they need promptly but also fosters a culture of safety and excellence in healthcare.
Written by the RCSEd NOTSS Committee:
Steven Yule (Chair)
Simon Paterson Brown
Richard Skipworth
Kenneth Walker
Francesca Stedman
Michael Carr
James Tomlinson
Alastair Murray
Chee Loong Yeap
Rosie Darwood
Shireen McKenzie
Gillian Hardman
Clare McNaught
Claire Falconer
Ashley McEwen
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