Surgical Safety in Children

Abstract

Awareness of the scale of unintended harm during healthcare delivery has increased dramatically in recent years, with the figure of 10% of hospital admissions suffering an adverse event now being generally accepted. Surgical care poses unique risks to patients, with approximately 50% of untoward surgical outcomes occurring in the operative phase. In accordance with other high-risk industries such as commercial aviation, the majority of these adverse events are not caused by failures of technical skill on the part of the individual surgeon but rather lie within the wider healthcare team and environment. Lapses and errors in communication, teamworking, leadership, situation awareness, or decision-making all feature highly in post hoc analysis of surgical adverse events. While system-based improvement programs can help reduce adverse events, they are not of themselves sufficient, and the possession and deployment of good non-technical skills by individual surgeons are now known to play a key role in optimizing outcomes for the surgical patient. The Non-Technical Skills for Surgeons (NOTSS) program has been developed to describe and assess these non-technical skills in the intraoperative environment. The NOTSS classification describes categories of situation awareness, decision-making, teamworking, and communication and leadership. Combined with an awareness of human performance limitation and tools to help improve teamworking and non-technical skills such as briefings and checklists, patient safety can be improved.