Impact of Non-technical Skills Training on Performance and Effectiveness of a Medical Emergency Team

The concept of non-technical skills training (NTST) arose in the aviation industry after observation that a number of avoidable incidents were caused by human error rather than mechanical failure. In medical training, clinical knowledge and skills are emphasised with little attention given to “human factors”. These encompass such aspects as leadership, team-working, communication and decision-making. Thus far, study in this area has been restricted to simulations. Our project aims to evaluate the impact of implementation of training in non-technical skills for our Medical Emergency Team (MET) service on team performance and patient outcomes. This will be a multi-partite quality improvement project run at the Lyell McEwin Hospital, a tertiary metropolitan hospital in Adelaide. We plan to perform a retrospective audit of existing MET service data to establish baseline data. Then a period of prospective study will occur before and after delivery of NTST to members of the MET service. Team attendances will be independently observed for demonstration of non-technical skills and patients will be tracked during their hospital admission. A pilot observation will also be conducted to validate the observational assessment tool and measure inter-rater reliability between the investigators. The primary outcomes will be 1) MET performance of non-technical skills as graded by a specifically developed qualitative assessment tool and 2) incidence of efferent limb failure as defined by a) requirement for a second MET attendance within 24 hours for the same calling criterion, b) unplanned admission to the Intensive Care Unit (ICU) within 24 hours of MET attendance, c) unexpected cardiac arrest and/or death within 24 hours of MET attendance. Secondary outcomes will include hospital and ICU length-of-stay, and vital status at hospital discharge. These will be used as a comparator between all periods of the project. NTST will be delivered to MET members by the investigators in collaboration with a group of active instructors from QANTAS and the Royal Australian Air Force Reserves. Oversight will be provided by the hospital Safety and Quality Unit. The baseline audit will include 2000 patients and the observational stage of the study is anticipated to enrol 600 patients, equally divided between the before- and after-NTST periods. We aim to demonstrate that training in non-technical skills improves MET service performance leading to a reduction in incidence of efferent limb failure. The anticipation is that this will then extrapolate to reductions in length-of-stay and mortality.