An observational study of technical and non-technical skills in advanced life support in the clinical setting

Abstract

<p>Objective<br>Technical skills (TS) and non-technical skills (NTS) are the primary elements ensuring patient safety during advanced life support (ALS) and effective crisis resource management (CRM). Both skills are needed to perform high-quality ALS, though they are traditionally practiced separately. The evidence of the association between NTS and TS in high-quality ALS performance is insufficient. Hence, we aimed to evaluate the association between the skills in real-life in-hospital ALS situations.</p><p>Methods<br>We video recorded real-life in-hospital ALS situations, analyzed TS and NTS demonstrated in them with an instrument measuring TS and NTS, and tested the linear association between NTS and TS using a linear mixed model.</p><p>Results<br>Among 50 real-life in-hospital ALS situations that we recorded, 20 had adequate data for analysis. NTS and TS total scores were associated with one another (slope 0.48, <em>P</em> < 0.001). All NTS subcategories were associated with the TS total score (slopes ranging from 0.29 to 0.39, <em>P</em> < 0.001). The NTS total score and TS subcategories (<em>chest compression quality, ventilation quality, rhythm control and defibrillation quality</em>) were associated with one another (slopes ranging from 0.37 to 0.56, <em>P</em> < 0.01).</p><p>Conclusions<br>The resuscitation teams who demonstrated good NTS also performed the technical aspects of ALS better. The results suggest that NTS and TS have an association with one another in real-life in-hospital ALS situations. NTS performance had the most evident association with chest compression quality and rhythm control and defibrillation quality; these are considered the most crucial elements affecting outcomes of ALS. The findings of the study present novel information of what and why to emphasize in ALS training.</p><p>Clinical trial registration. ClinicalTrials.gov, NCT03017144.</p>