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
9.
10. • Two categories
Cognitive &mental skills: planning, situational
awareness &decision making
Social &interpersonal skills :coordinated team
work, communication &leadership
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.
18. • Co-ordinating activities with team members
• Exchanging information
• Using authority and assertiveness
• Assessing capabilities
• .Supporting others
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
27.
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
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
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)
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
Editor's Notes
Too much knowledge acquired for anesthetist
To be able to assess, prepare, plan , maintain anesthesia and deal with morbidities
Anesthetist should very skilled regarding basic and advanced airway management , vascular access , regional blocks , using US , ACLS skills
The term NTS first developed in 1990 by european civil aviation. The aviation industry uses behavioral marker systems to structure the training and assessment of pilot crew resource management (CRM)
The taxonomy ANTS developed for the same purpose
This offer a method for evaluating performance, and improve the quality of feedback to trainees.
Incident Reporting 2. Observational studies in real life 3.Virtual observational studies in simulation centres. 4.Attitude Questionnaires & 5. Theoretical Models.
Behavioural markers for good practice-- lays out drugs and equipment needed before starting case. Behavioural markers for poor practice--does not ask for drugs or equipment until the last minute or does not have emergency/alternative drugs
Behavioural markers for good practice--crosschecks drug labels, checks machine at beginning of each session, maintains accurate anaesthetic records • Behavioural markers for poor practice--does not check blood with patient and notes, fails to confirm patient identity and consent details
• good practice-- allocates tasks to appropriate member(s) of the team. • poor practice--overloads team members with task
distractions from the use of personal electronic devices in the operating room for purposes not related to patient care
Technology has advanced many aspects of the practice of anesthesiology including, but not limited to: immediate availability of patient medical records, more efficient communication and connectivity, contemporaneous documentation, improved legibility in the medical record, clinical decision support, and data acquisition, management and analyses
a 2009 study examined the effects of reading in the OR on vigilance and workload during anesthesia care and concluded there were no scientific data that intraoperative reading and non patient-related conversation during low-workload portions of the maintenance phase of anesthesia adversely affect vigilance or multi-tasking.
good practice- watches surgical procedure, verify status poor practice-does not ask questions to orient self to situation during hand-over
Anticipating – asking ‘what if’ questions and thinking ahead about potential outcomes and consequences of actions, intervention, nonintervention, etc • good practice- reviews the effects of an intervention • poor practice- does not foresee undesirable drug interactions
3.Identifying options – generating alternative possibilities or courses of action to be considered in making a decision or solving a problem
"Learn something about the physician — where they live, kids, hobbies and remember it for future interactions. Who knows, you may make a lifelong friend,
The rule regulates how pilots and flight crew do their jobs.
