The Assessment of Registrars’ Non-technical Skills in the Emergency Department

Abstract

In recent years safety in medicine has been high on the agenda, both for government and for healthcare providers. This thesis starts by describing the evolution of patient safety and then goes on to explore error specifically in the Emergency Department (ED). Focus is drawn to the role of non-technical skills for improving safety. The initial broad aim of this research was to learn how the ED team could function better to improve patient care. An interview study is developed to investigate how ED staff change their behaviour during periods of high demand and to determine the direction of future research. This study highlights that staff would benefit from increased awareness of the nontechnical skills that contribute to effective teamwork and enhanced patient safety. The interviews also reveal the leadership role of the registrar is of particular importance. Therefore, a series of studies are developed to identify and describe the non-technical skills required by Emergency Medicine trainees, with a specific focus on leadership. The process of developing a provisional assessment tool for assessing non-technical skills in the ED is described. This draws on published literature and curricula as well as considering existing methods of assessment. The assessment tool is revised using re-analysis of staff interviews and a series of preliminary observations in the ED. Content validity of the tool is measured using a survey of expert opinion and this helps to further refine the tool components. An experimental study reveals that whilst adequate levels of inter-rater reliability are achievable, rater accuracy appears to be more problematic. Various sources or rater error are also explored and this leads onto a larger, multicentre observational study investigating use of the tool in the workplace. Further data for reliability is collected and field notes are analysed to provide a detailed description of the non-technical skills displayed by ED registrars. Findings of the studies are summarised and limitations, applications and further research are discussed.