Use of a ‘non-technical skills for surgeons’ system and checklist to reduce errors and improve safety on surgical wards

Royal College of Surgeons of Edinburgh

  • Led by the Royal College of Surgeons of Edinburgh, in partnership with NHS Lothian and the University of Edinburgh.
  • Implemented at the Royal Infirmary of Edinburgh.
  • Initiative that focused on the many adverse events experienced by patients on wards rather than operating theatres.
  • Used an adapted non-technical skills for surgeons system and a ward round based structured checklist to reduce errors and improve safety on surgical wards.

This project led by the Patient Safety Board of the Royal College of Surgeons of Edinburgh involved educating staff on a general surgical unit in a university teaching hospital on non-technical skills and introducing a quality improvement tool to help bring consistent structure to surgical ward rounds.

Surgical wards are fast-paced, covering a large number of patients with varying conditions, over a short period of time. It has been shown that the non-technical skills of staff contribute just as much to the quality of patient care as technical skills.

Staff in the general surgical unit at the Royal Infirmary of Edinburgh indicated that the emergency surgical ward rounds lacked structure and consistency, which impacted on patient care. This project involved developing a training programme on non-technical skills; based on the NOTSS (Non-Technical Skills for Surgeons) training programme that teaches surgeons about non-technical skills in the operating theatre. The programme developed consisted of pre-course reading, a 40-minute training programme supplemented by video scenarios and activities and finishing with a group discussion. The programme was delivered to the majority of the department’s nursing and medical staff over a period of four weeks. A quality improvement tool was also developed through focus groups with staff.

Post-intervention data have revealed a statistically significant improvement in both clinical task completion and non-technical skills. The ward round tool has now become standard practice in the department.

Key to the success of the project was involving staff in the quality improvement from the start, even staff members who were initially resistant to the proposals participated after they were involved in the planning process.

Contact details

For further information about the project, please email the Research team at the Health Foundation.

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