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Editors Selection IGR 11-4

Surgical Therapy: Safe eye surgery: non-technical aspects

Comment by George Lambrou on:

46373 Safe eye surgery: non-technical aspects, Azuara-Blanco A; Reddy A; Wilkinson G et al., Eye, 2011; 25: 1109-1111

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'Team-spirit', 'leadership', 'communication skills'.. Are these and other 'soft-skill' buzzwords, common in the boardrooms of the corporate world, about to invade the aseptic environment of our Operating Rooms? Several studies have shown that 'behavioral' aspects of performance are more frequent causal factors for medical errors during surgery than lack of technical expertise. Furthermore, among surgical specialties, Ophthalmology seems to occupy the first place in surgical errors, due first and foremost to wrong IOL implantation, while anesthetizing the wrong eye is a close second.

Behavioral aspects of performance are more frequent causes for surgical errors than lack of technical expertise

The medical profession increasingly recognizes that there is more to good surgical practice than clinical knowledge and solid technical skills. Anaesthetists have developed aviation-style Crisis Resource Management courses and, for surgeons, a Non-Technical Skills taxonomy and rating system (NOTSS) has been developed. Taught by the Royal College of Surgeons in Edinburgh and used in several countries, NOTSS has been incorporated in the professional standards of the Australasian College of Surgeons. For various reasons, including high turnover, reliance on highly sophisticated specialized equipment and limitations on verbal communication imposed by consciousness of the patient during surgery, Ophthalmology is a specialty of choice for implementation of validated non-technical skill courses. Ideally, both non-technical and technical aspects of training should be integrated for achieving the best and safest possible surgical practice as has been pointed out by Azuara Blanca et al. (1673).

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