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1.  Do technical skills correlate with non-technical skills in crisis resource management: a simulation study 
BJA: British Journal of Anaesthesia  2012;109(5):723-728.
Both technical skills (TS) and non-technical skills (NTS) are key to ensuring patient safety in acute care practice and effective crisis management. These skills are often taught and assessed separately. We hypothesized that TS and NTS are not independent of each other, and we aimed to evaluate the relationship between TS and NTS during a simulated intraoperative crisis scenario.
This study was a retrospective analysis of performances from a previously published work. After institutional ethics approval, 50 anaesthesiology residents managed a simulated crisis scenario of an intraoperative cardiac arrest secondary to a malignant arrhythmia. We used a modified Delphi approach to design a TS checklist, specific for the management of a malignant arrhythmia requiring defibrillation. All scenarios were recorded. Each performance was analysed by four independent experts. For each performance, two experts independently rated the technical performance using the TS checklist, and two other experts independently rated NTS using the Anaesthetists' Non-Technical Skills score.
TS and NTS were significantly correlated to each other (r=0.45, P<0.05).
During a simulated 5 min resuscitation requiring crisis resource management, our results indicate that TS and NTS are related to one another. This research provides the basis for future studies evaluating the nature of this relationship, the influence of NTS training on the performance of TS, and to determine whether NTS are generic and transferrable between crises that require different TS.
PMCID: PMC3470444  PMID: 22850221
cardiopulmonary resuscitation; clinical competence; medical education; patient simulation
2.  Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections 
Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence‐based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections.
27 semi‐structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the timely administration of prophylactic antibiotics. Using a grounded theory approach, transcripts were analyzed for recurrent themes.
Despite having knowledge of guidelines, participants perceived consistent failure in the proper timing of antibiotic administration. Thematic analysis revealed a number of obstacles to the observance of guidelines including: (1) low priority, (2) inconvenience, (3) workflow, (4) organizational communication, and (5) role perception. Workflow and role perception were the dominant obstacles.
This study suggests that proper antibiotic timing is thwarted by significant obstacles. The gap between evidence‐based guidelines and practice is populated by individual values, professional conflicts, and organizational conflicts which must be addressed in order to achieve optimal practice in this domain. Using group interviews to reveal these factors to team members and managers may be a first step to resolving the gap and reducing surgical site infections.
PMCID: PMC2563990  PMID: 16456207
surgical site infections; prophylactic antibiotic timing; evidence‐based practice

Results 1-2 (2)