Safer Surgery part 14. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 104 Safer Surgery Figure Escalation model of surgical error threats and increasing the likelihood of further error creating a cascade that leads to more serious surgical problems and subsequently to harm or adverse event. Threats either predispose errors that cause minor failures in process or directly cause minor failures themselves. These minor failures either lead to more threats and so to more errors or lead directly to more serious or potentially dangerous major failures. Major failures may expose more threats create more errors and can lead directly to an adverse outcome Catchpole et al. 2005 . Though we did not directly measure surgical outcomes or observe any death in more than 40 cases the Great Ormond Street team observed over 500 minor problems and 8 major problems that represented considerable lapses in the quality of care given and a serious threat to the safety of the patient. The reader is directed to our accompanying chapter Catchpole Chapter 19 in this volume that describes the results in orthopaedic surgery. The multidisciplinary cross-industry team wondered why some operations went more smoothly than others and why in some operations even a large number of small problems did not result in serious problems. In part the research team observed that the escalation from small Rating Operating Theatre Teams 105 seemingly innocuous problems to these sometimes life-threatening situations was dependent upon the type of operation performed and the risk or complexity of the operation. Some operations had more critical stages and so the coincidence of a minor problem at a critical time might also be more likely and also certain operations would be more demanding and thus might be more likely to result in human errors or were more sensitive to the overloading of individual mental and physical capacity. The Great Ormond Street team therefore concluded that nontechnical skills which are specifically trained for in aviation to address these types of .
