Clinical Trial Details
— Status: Not yet recruiting
Administrative data
NCT number |
NCT06257511 |
Other study ID # |
K99_01 |
Secondary ID |
|
Status |
Not yet recruiting |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
June 2025 |
Est. completion date |
June 2030 |
Study information
Verified date |
January 2024 |
Source |
Northwestern University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Teams of several medical professionals conduct high-risk cardiac surgical procedures. These
professionals work in complex, stressful operating room environments requiring effective
communication and teamwork skills. Surgeons, anesthesiologists, perfusionists, nurses, and
surgical technicians working in this environment are also vulnerable to human errors.
Non-technical skills for surgeons (NOTSS), defined as cognitive skills (situation awareness,
decision making) and social skills (leadership, communication, and teamwork) underpinning
medical knowledge and technical skills, are essential contributors to better cardiac surgery
outcomes. Yet most of the surgical education programs focus only on technical skills, and
interventions to improve the non-technical skills of cardiac surgical teams are scarce. The
proposed research will develop and pilot-test and evaluate the preliminary effectiveness of
an intervention to improve the non-technical skills of cardiac surgical teams.
Description:
Over 290,000 Coronary Artery Bypass Graft (CABG) and valve replacement surgeries are
performed in the US annually. Around 30% of patients undergoing CABG experience a
complication. Notably, hospitals and surgeons with high CABG and valve surgery volumes are
more likely to achieve better outcomes. In other surgical specialties, more than 50% of
surgical complications are attributable to ineffective non-technical skills for surgeons
(NOTSS), defined as cognitive skills (situation awareness, decision making) and social skills
(leadership, communication, and teamwork) underpinning medical knowledge and technical
skills. The previous work and others found that better non-technical skills were associated
with improved risk-adjusted rates of any post-operative complication, mortality, return to
the operating room, and intraoperative performance. The investigator have also reported that
non-technical skills training programs for general surgeons can effectively improve NOTSS and
are associated with improved Operating Room (OR) performance metrics, fewer unplanned
reoperations, decreased length of hospital stay, and lower mortality rate. Given our prior
work, it is likely that Non-Technical Skills for Cardiac Surgery (NOTSCS) are also important
contributors to better cardiac surgery outcomes.
Cardiac surgery procedures are technically challenging for the surgeons and physiologically
disruptive for patients, e.g. circulatory arrest, cardiopulmonary bypass, with very little
physiologic reserve as a result of their cardiac disease. Cardiac surgeries are conducted by
different teams each composed for specialized medical professionals working in concert and
relieving each other to support creation of new anatomical structures in the heart (surgery
team), cardiopulmonary function (anesthesia team), perfusion to vital organs (perfusionist
team), transfusion (blood management team), provision of medicines (operating room pharmacy
team) and provision of tools and implants (nursing team). The dramatic and unexpected
physiologic changes that occur, large number of medical professionals, extreme
sub-specialization of medical professionals, ad-hoc nature of the teams, steep hierarchy
between medical professionals and participation of learners all make cardiac surgery
operating rooms highly stressful environments. Individuals working in this stressful
environment are highly vulnerable to human errors that lead to complications. Yet most of the
surgical education programs focus only on technical skills, and interventions to improve the
non-technical skills of cardiac surgical teams are scarce. Therefore, there is an urgent need
to develop tailored, cardiac surgery-specific interventions to improve the NOTSCS and to
assess their effect on patient outcomes.
The goal of this K99/R00 is to develop and test an intervention to improve the non-technical
skills of cardiac surgical teams. The investigators will develop, pilot test, refine, and
assess the effect of a NOTSCS intervention by applying principles of simulation-based mastery
learning (SBML). SBML allows learners to deliberately practice skills until they achieve a
mastery level. Most importantly, this application will allow for my development as an
independent investigator focused on improving NOTSCS, with a long-term goal of improving
cardiac surgery outcomes. The aims of this application are:
K99 Aim 1: To adapt existing non-technical skills performance metrics to cardiac surgical
teams. The investigators will identify the behavioral markers required to enhance
intraoperative non-technical skills performance for the cardiac surgery teams at academic and
community hospitals.
K99 Aim 2: To adapt refine and pilot test an existing NOTSS improvement intervention for
cardiac surgery-specific skills, environments, and teams, and assess barriers and
facilitators to its implementation.
R00 Aim 1: To assess the preliminary effectiveness of NOTSCS on OR times and patient
outcomes.
The research team will implement the NOTSCS intervention to cardiac surgical teams from two
academic hospitals. The hypothesis is that a non-technical skills improvement program will be
associated with increased NOTSS behaviors, decreased OR time, cardiopulmonary bypass time,
time on/off pump, intraoperative bleeding requiring transfusion, and unplanned return to the
operating room.
R00 Aim 2: To examine implementation acceptability, feasibility, appropriateness of a SBML
NOTSCS intervention. Using quantitative and qualitative feedback, the investigators will map
barriers and facilitators to an implementation framework to address barriers to the NOTSCS
intervention.