More than Non-Technical Skills: Trauma resuscitation teamwork performance affected by patient and provider factors

Purpose: Assessment of nontechnical skills during trauma resuscitations has previously been validated by expert reviewers. We hypothesized that a modified Trauma-Non-Technical Skills (T-NOTECHS) scale would yield a reliable assessment of trauma leaders, independent of assessors’ experience in the evaluation of non-technical skills. Methods: Video recordings of highest-level trauma activations at two Level 1 trauma centers from one year were included. We utilized a modification of the T-NOTECHS instrument to measure five domains on a 3-point scale. Assessments were conducted at a video review session by raters from various disciplines. Inter-rater reliability was categorized as poor, some, good, or excellent. Factors affecting non-technical performance were reviewed. Results: One thousand three hundred sixty-nine modified NOTECHS scorecards from 230 video reviews were submitted. When assessing per video review, 75% of videos had “good” agreement of scores, and more than half had “excellent” agreement. In contrast, when grouped by individual trauma attendings, agreement coefficients were significantly lower (median = 0.81 vs 0.66, p<0.001). Subset analysis demonstrated better performance for transfer patients and worse performance for patients requiring intubation. Conclusions : The modified NOTECHS score is a reliable objective instrument for rating nontechnical skills, even when performance is assessed by a variety of disciplines and not expert reviewers. Specific factors likely account for variability in trauma leaders’ performance scores between cases. More studies may elucidate other variables that can affect non-technical skill performance.