Non-technical skills in the intensive care unit

In high-risk industries such as aviation, the skills not relateddirectly to technical expertise, but crucial for maintainingsafety (e.g. teamwork), have been categorized as non-technicalskills. Recently, research in anaesthesia has identified anddeveloped a taxonomy of the non-technical skills requisite forsafety in the operating theatre. Although many of the principlesrelated to performance and safety within anaesthesia are relevantto the intensive care unit (ICU), relatively little researchhas been done to identify the non-technical skills requiredfor safe practice within the ICU. This review focused upon criticalincident studies in the ICU, in order to examine whether thecontributory factors identified as underlying the critical incidents,were associated with the skill categories (e.g. task management,teamwork, situation awareness and decision making) outlinedin the Anaesthetists' Non-technical Skills (ANTS) taxonomy.We found that a large proportion of the contributory factorsunderlying critical incidents could be attributed to a non-technicalskill category outlined in the ANTS taxonomy. This is informativeboth for future critical incident reporting, and also as anindication that the ANTS taxonomy may provide a good startingpoint for the development of a non-technical skills taxonomyfor intensive care. However, the ICU presents a range of uniquechallenges to practitioners working within it. It is thereforenecessary to conduct further non-technical skills research,using human factors techniques such as root-cause analyses,observation of behaviour, attitudinal surveys, studies of cognition,and structured interviews to develop a better understandingof the non-technical skills important for safety within theICU. Examples of such research highlight the utility of thesetechniques.