A Ward-Round Non-Technical Skills for Surgery (WANTSS) Taxonomy

Abstract

Background: Around half of surgical adverse events occur outside the operating room. However the majority of non-technical skills (NTS) training programs have been developed for the intra-operative environment. Ward rounds are a crucial part of extra-operative care and to date no specific NTS training manual has been developed targeting emergency general surgical ward rounds. Aim: To develop a NTS taxonomy for emergency general surgical ward rounds that can be used to improve surgical team members' NTS and improve outcomes. Methods: A literature review of existing NTS taxonomies was conducted, followed by semi-structured interviews and observational data collection, to determine good and poor surgical ward round behaviours. These behaviours were reviewed by a panel of subject matter experts and categorised into a taxonomy, using the Non-Technical Skills for Surgeons (NOTSS) taxonomy framework as a guide. Results: The Ward-round Non-Technical Skills for Surgery (WANTSS) taxonomy includes examples of good and poor ward round specific behaviours, grouped into elements and categories. The taxonomy can be used as both a training and teaching manual for the surgical team. Conclusion: Ward rounds are a crucial part of extra-operative surgical care. The WANTSS taxonomy provides surgical teams with a manual to help them improve their ward round NTS.

How can we better prepare new doctors for the tasks and challenges of ward rounds?: An observational study of junior doctors’ experiences

“…Our data add to the literature and can be used to aid simulation design. A taxonomy of non-technical surgical ward round skills (WANTSS) has recently been produced describing specific desirable behaviours (Klaas et al 2020) and is likely to be applicable in other disciplines. Other helpful approaches such as structured proformas and checklists are increasingly seen in quality improvement projects (Banfield et al 2018;Mattinson and Cheeseman 2018) and maybe useful learning tools.…”

Role of Briefing and Debriefing in Running Surgical Ward Round Effectively: A Prospective Observational Study

“…Several models and interventions have been suggested to conduct a SWR safely with maximum effectiveness [1][2][3][4][5][6][7][8]. There has been significant variations in the conduction of SWR depending upon the seniority of clinical lead (consultant versus registrar), type of patients (old patients versus new admissions) and the settings of SWR (on-call team versus non on-call team).…”

“…This diverse and complex cohort of surgical patients can pose significant diagnostic and management challenges and therefore, their adequate review during SWR can undoubtedly improve safety of the patients. Various measures to improve the effectiveness of SWR has been reported with variable success [1][2][3][4][5][6][7][8]. SWR constitute a keystone of safe hospital surgical practice and poor-quality SWR can lead to a greater number of adverse events risking the safety of the patients, thereby cascading to an increased financial strain on our already burdened healthcare system of NHS [8].…”

Improving Healthcare Workers' Adherence to Surgical Safety Checklist: The Impact of a Short Training

“…This also means an increase in the length of hospitalization and costs. Many surgical adverse events originate from failures in non-technical aspects such as leadership, situation awareness, decision making, and especially communication and teamwork among operators (5,6). Some special incidents within healthcare have been included in a list known as "never events, " which are defined as wholly preventable serious healthcare-related adverse events (7).…”

“…This also means an increase in the length of hospitalization and costs. Many surgical adverse events originate from failures in non-technical aspects such as leadership, situation awareness, decision making, and especially communication and teamwork among operators ( 5 , 6 ).…”