Development of a behavioural marker system for scrub practitioners' non-technical skills (SPLINTS system)

Area of Science:

• Surgical Education
• Patient Safety
• Human Factors in Medicine

Background:

• Adverse events in healthcare persist despite efforts to minimize patient harm.
• Limitations in clinicians' non-technical skills (e.g., communication, situation awareness) are significant contributors to adverse events, often more so than technical deficiencies.
• There is a need for structured methods to teach and assess these non-technical skills.

Purpose of the Study:

• To develop a behavioral rating system for teaching and assessing scrub practitioners' non-technical skills.
• To create a structured approach to improve performance in critical intraoperative tasks.

Main Methods:

• Focus groups with experienced scrub practitioners (n=16) were conducted to develop a preliminary taxonomy of non-technical skills.
• An expert panel refined the taxonomy through an iterative process, defining skill categories and elements with examples of good and poor performance.
• The development involved reviewing interview data and collaboratively refining skill labels.

Main Results:

• A preliminary taxonomy initially included eight non-technical skill categories and 28 elements.
• The expert panel refined this into a final taxonomy with three core categories: situation awareness, communication and teamwork, and task management, each with three elements.
• The resulting system is named the Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS), including a scoring system and user handbook.

Conclusions:

• A prototype behavioral rating system (SPLINTS) for scrub practitioners' non-technical skills has been successfully developed.
• This system provides a tool for teaching and formative assessment of crucial non-technical skills in the operating room.
• Currently, these essential non-technical skills are not explicitly addressed in the educational pathways for scrub practitioners.