This document discusses the importance of non-technical skills like communication and teamwork in ensuring safety in the operating room (OR). It outlines how breakdowns in communication are a leading cause of conflicts in healthcare. It promotes establishing mutual respect between surgeons and anesthesiologists, open communication from the start of a procedure, and remembering their shared goal of best serving the patient. Effective non-technical skills can help mitigate errors, especially during high-risk phases like induction and emergence from anesthesia, analogous to takeoff and landing in aviation.

1. Usama Elsayed Abdalla, MD

2. • What is needed for Safety and
efficiency in anesthesia practice
• Sterile cockpit concept

3. • knowledge
• Technical skills
• Non technical skills

7. Tenerife accident
(1977)
Non technical skills

8. ANTS
European civil aviation 1990 , Airline
Pilots
Cognitive, social and personal resource
skills that complement technical skills,
and contribute to safe and effient task
performance

10. • Two categories
Cognitive &mental skills: planning, situational
awareness &decision making
Social &interpersonal skills :coordinated team
work, communication &leadership

13. • Planning &preparation
• Prioritisation
• Identifing &utilising resources
• Providing & maintaining standards

14.  Gathering information
 Recognizing & understanding
 Anticipating

15. Distracted doctoring
Use of personal electronic devices (PEDs) in OR
Reading in the OR
• Cammarata BJ, Thomas BJ. Technology’s escalating impact on perioperative care: clinical, compliance, and medicolegal
considerations. APSF Newsletter 2014;29:3-5.
• Slagle JM, Weinger MB. Effects of intraoperative reading on vigilance and workload during anesthesia care in the academic
medical center. Anesthesiology 2009;110:275-83.

17. • Identifying options
• Balancing risks & benefits
• Re evaluation

18. • Co-ordinating activities with team members
• Exchanging information
• Using authority and assertiveness
• Assessing capabilities
• .Supporting others

23. .
Patient
loss

24. • Surgeons v. Anaesthetists : Why the
Tensions?

25. • The Anaesthetists is often called the
'captain of the ship,' but the surgeon has a
crucial role in how smooth the sailing is.

26. How to improve communication in
OR ?
• Have mutual respect
• Mutual respect between the two specialists is
the number one way to reduce friction in the
OR
• Egos need to be checked in at the door, avoid
talking-down to the OR team

28. How to improve communication in
OR ?
 A good surgeon will also respect an
anesthestist’s instructions inside the O.R.
when safety is at issue.
 The command is not personal; the patient’s
safety is at issue; and no surgeon wants a
patient coding on the table.

29. Both surgeon and anesthetist need to be assertive and
preemptive when explaining potential issues, whether it's
during, immediately prior to or even days before the surgical
procedure

30. • "Say hi, shake hands, express your
appreciation for working together today and
ask the surgeon if there are any issues about
this particular patient, this particular case
• The first communication of the day should
never be 'the blood pressure is falling'."

31. • The more comfortable the surgeon and
anesthesiologist are with each other, the
more likely they will be to address their
thoughts and concerns about the procedure
in an open manner.

32. Getting to know each other personally outside the
OR can help surgeons and anesthesiologists
develop that comfort level.

33. The anesthetic crew able to see over the ‘ether
screen’ and communicate easily with the
surgeon. In turn, the surgical crew should be
able to see the anesthetic monitors

34. Closed loop communication

35. • It's essential that both physicians remember
why they are in the operating room in the first
place to ensure the best care for the
patient
• Over time, faith develops between the two
and both trust that the other is doing their
best for the patient."

36. • Breakdowns in communication are one of the
most frequent causes of conflict in health care
• The OR is at risk for conflict because:
– There are many different professionals with
overlapping and sometimes poorly delineated
responsibilities
– Complex, high-pressure work environment
– Sleep deprivation and stress affect interactions
– Ethical conflicts and conflicts of interest may emerge

37. Medical error ≠ lack of knowledge or technical
expertise but most of it due to lack of non
technical skills

38. Communication failure

39. In aviation, The sterile cockpit rule prohibits
non-essential activities during critical phases
of flight, takeoff and landing, phases
analogous to induction of, and emergence
from, anaesthesia
all other flight operations conducted below
10,000 feet( borderline hemodynamics)

40. A sterile cockpit and a sterile
OR have some critical
similarities

41. • Non technical skills is important to mitigate
the effects of the errors in the areas where
SAFETY is a paramount concern.

42. TO SUM UP
Communication among OR team
members should be subtle and
complex not like the openly
combative style that is the stuff of
OR myth.
The goal of effective
communication in OR is to reduce
tension