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 and associated with more efficient resuscitations. We hypothesized that a modified Trauma-Non-Technical Skills (T-NOTECHS) scale used during trauma video review would yield a reliable assessment of trauma leadership and communication, 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 of different skill levels and not only expert reviewers. Having a scoring tool that can reliably be used by individuals of different levels makes it versatile and adaptable across a multitude of situations which can enhance the tool’s utility in diverse settings and team compositions.