The assessment of non-technical skills in the emergency department

Introduction Analysis of adverse events in the Emergency Department (ED) reveals that contributory factors commonly relate to non-technical skills such as decision-making. Crisis Resource Management courses, designed to improve non-technical skills, invariably centre on the critically ill patient. While resuscitation is undeniably important, little attention has been paid to the skills necessary for routine management of the ED and the vital leadership role of registrars. Furthermore, many UK trainees receive little specific assessment or feedback on the behavioural aspects of performance. Aim To produce an observational tool for the assessment of registrar non-technical skills in the ED, with a particular focus on leadership. Methods Following a successful feasibility study, data was gathered from a variety of sources to allow subsequent triangulation of results. A literature review was undertaken to explore the evidence linking non-technical skills to safety in the ED. Various curricula were studied to ensure the observational tool reflected these competencies. Transcripts from an interview study with ED staff were analysed to determine which skills were considered to be important for effective teamwork. A series of observations were carried out to identify skills that were both observable and sufficiently common. The final skill set was reviewed by a team of behavioural psychologists and Emergency Medicine (EM) physicians. Results A taxonomy for non-technical skills was developed that consisted of 12 skills, each with observable behaviours indicative of good or poor performance. These skills were organised into four categories: (1) supervision and management; (2) teamwork and cooperation; (3) decision-making and (4) situation awareness. Discussion This observational tool is empirically based in Emergency Medicine and explicitly describes the skills required to structure observation and feedback for trainees during everyday activities. The validity of the skills taxonomy is currently being tested and future studies are planned to assess reliability, usability and acceptability.