Defining Preliminary Core Nontechnical Skills for Anesthesia Crisis Management in Indonesia: An Expert Consensus from a Modified Delphi Study Emphasizing Communication and Situational Awareness.

PURPOSE: To identify, through expert consensus, a preliminary set of core nontechnical competencies for anesthesia crisis management in Indonesia, with particular emphasis on situational awareness and communication.

PATIENTS AND

METHODS

This exploratory sequential qualitative study was conducted in Indonesia between January and December 2025. Phase one comprised a structured literature review using the Population, Concept, and Context framework across four databases, yielding 17 included studies. Phase two employed a modified Delphi method with a purposively sampled expert panel of 13 professionals, including anesthesiologists, nurse anesthetists, non-anesthesia surgical specialists, and patient-safety and education leaders, drawn from seven institutions across four Indonesian cities. Competencies were rated on a 4-point Likert scale, with responses dichotomised for analysis (ratings of 3 or 4 indicating agreement) and consensus predefined at ≥75% agreement. Content validity was evaluated using item- and scale-level content validity indices.

RESULTS

The literature review identified communication and situational awareness as the most consistently operationalized competencies in crisis-oriented instruments. Through two Delphi rounds with a 100% response rate, consensus was reached on 11 final competency items: five in communication and six in situational awareness. First-round agreement averaged 96% (range 82-100%). All items achieved an item-level content validity index of 1.00, yielding a scale-level content validity index of 1.00.

CONCLUSION

Situational awareness and communication emerged as the core nontechnical competency domains for anesthesia crisis management in the Indonesian context. These findings constitute a preliminary, expert-consensus framework with content-validity evidence within the panel, providing a theoretically informed foundation for national anesthesia training and assessment; pilot implementation, inter-rater reliability, and construct and criterion-related validity are required next steps before operational deployment.