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. 2023 Apr;165(4):1462-1469.
doi: 10.1016/j.jtcvs.2021.06.052. Epub 2021 Jul 2.

A tool to assess nontechnical skills of perfusionists in the cardiac operating room

Roger D Dias  1 , William Riley  2 , Kenneth Shann  3 , Donald S Likosky  4 , David Fitzgerald  5 , Steven Yule  6
Affiliations

A tool to assess nontechnical skills of perfusionists in the cardiac operating room

Roger D Dias et al. J Thorac Cardiovasc Surg. 2023 Apr.

Abstract

Objectives: This study aimed to develop the Perfusionists' Intraoperative Non-Technical Skills tool, specifically to the perfusionists' context, and test its inter-rater reliability.

Methods: An expert panel was convened to review existing surgical nontechnical skills taxonomies and develop the Perfusionists' Intraoperative Non-Technical Skills tool. During a workshop held at a national meeting, perfusionists completed the Perfusionists' Intraoperative Non-Technical Skills ratings after watching 4 videos displaying simulated cardiac operations. Two videos showed "good performance," and 2 videos showed "poor performance." Inter-rater reliability analysis was performed and intraclass correlation coefficient was reported.

Results: The final version of the Perfusionists' Intraoperative Non-Technical Skills taxonomy contains 4 behavioral categories (decision making, situation awareness, task management and leadership, teamwork and communication) with 4 behavioral elements each. Categories and elements are rated using an 8-point Likert scale ranging from 0.5 to 4.0. A total of 60 perfusionist raters were included and the comparison between rating distribution on "poor performance" and "good performance" videos yielded a statistically significant difference between groups, with a P value less than .001. A similar difference was found in all behavioral categories and elements. Reliability analysis showed moderate inter-rater reliability across overall ratings (intraclass correlation coefficient, 0.735; 95% confidence interval, 0.674-0.796; P < .001). Similar inter-rater reliability was found when raters were stratified by experience level.

Conclusions: The Perfusionists' Intraoperative Non-Technical Skills tool presented moderate inter-rater reliability among perfusionists with varied levels of experience. This tool can be used to train and assess perfusionists in relevant nontechnical skills, with the potential to enhance safety and improve surgical outcomes.

Keywords: assessment; behavioral markers; cardiac surgery; nontechnical skills; patient safety; perfusionist; teamwork.

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Conflict of interest statement

CONFLICT OF INTEREST:

RD Dias, W Riley, D FitzGerald, D. Fitzgerald, and K. Shann have no conflicts of interest. DS Likosky is a consultant to AmSECT. Dr. Likosky reports funding from the AHRQ and NHLBI

S Yule is a member of the Global Education Council, Johnson and Johnson Institute This project was funded by the National Heart, Lung, and Blood Institute (NHLBI; R01HL146619).

Figures

Figure 1
Figure 1
The Perfusionists’ Intraoperative Non-Technical Skills (PINTS) tool. The left column shows behavioral categories, and the right column shows the behavioral elements within each category. The scale in the bottom shows the 8-point anchoring system used for assessment.
Figure 2
Figure 2
Distribution of perfusionist raters as absolute number (N) and percentage (%) according to experience in years.
Figure 3
Figure 3
Distribution of ratings (percentage) across all possible scores (0.5 to 4.0) for each behavioral category: decision making, situation awareness, task management and leadership, and teamwork and communication.
Figure 4
Figure 4
Heatmap showing the distribution of ratings (percentage) based on raters’ experience in years. The frequency increases in the color spectrum from yellow to red.
Figure 5
Figure 5
Comparison between “poor performance” and “good performance” videos regarding the distribution of ratings. The boxplots display median, 1st and 3rd quartiles, minimum and maximum values.
Figure 6
Figure 6
Graphical Abstract displaying the study methods involving an expert panel to develop the Perfusionists’ Intraoperative Non-Technical Skills (PINTS) tool; the main findings involving 60 perfusionists responding to an online survey after watching 4 simulated cardiac surgery videos; the comparison between videos showing good and poor behavior’s; and the take-home message highlighting the potentials uses of the PINTS tool..
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