Treinamento de habilidades não-técnicas em unidades de terapia intensiva: uma revisão sistemática

Abstract

Non-technical skills are social, personal, and cognitive skills that can influence safety and efficiency in performing tasks. Studies show that in intensive care units, most safety incidents have low performance in these skills as their root cause, and training programs are an alternative to solving this problem. This study aimed to analyze the effect of implementing non-technical skills programs in intensive care units based on Kirkpatrick's evaluation model for training programs, which includes reaction to training, learning, behaviors, and organizational results. For this, we perform a systematic review, registered on the PROSPERO platform under the code: CRD42021244769. We review original articles published in the following databases/portals: Pubmed/Medline, Scopus, Web of Science, Science Direct, CINHAL, EMBASE, and PsycINFO. We include randomized clinical trials, quasi-experimental studies with a control group, or studies with a before and after design. The risk of bias for the included studies was assessed using the Risk of Bias 2, Risk of Bias in Non-randomized Studies of Interventions, and NHI Assessment Tool for Before and After Studies tools. Two pairs of reviewers independently selected and evaluated the works, and in case of disagreement, we consulted the fifth reviewer. From a universe of 3976 documents identified in the databases/portals, 14 studies were included in the review. In the reaction dimension, the participants evaluated the training programs as useful, even though the teaching strategies implemented were different. Only one study explored the effect of the training program on the learning dimension, however, the difference was not significant. We identified a positive relationship between the adoption of non-technical skills training programs and the improvement of teamwork behaviors, situational awareness, leadership, and communication. In the organizational results, there were no significant changes observed in patient safety culture, as well in the length of stay and mortality rates, and the improvement of process indicators was limited. The analysis of the risk of bias indicated a low methodological quality, mostly linked to the way of measuring the outcomes, predominantly self-reported. The adoption of non-technical skills training programs in intensive care units shows limited effects, but they can contribute to the existing professional training curriculum.