Non-technical skills in acute care: an umbrella review of assessment, training, and implications for emergency department practice.

Background: Non-technical skills (NTS), including communication, teamwork, leadership, situational awareness, and decision-making, are widely recognized as essential for safe and effective performance in high-risk healthcare environments. Although extensive research has examined NTS training and assessment across healthcare settings, the evidence base is fragmented, and its applicability to emergency department (ED) practice remains unclear. This umbrella review synthesizes review-level evidence on NTS assessment tools and training approaches in healthcare and examines their implications for emergency department practice. Methods: A systematic search was conducted across PubMed (MEDLINE), Scopus, Cochrane Library, Web of Science, and EBSCOhost (CINAHL, APA PsycInfo, and Academic Search Complete) from inception to February 2025. Eligible studies included systematic, scoping, and narrative reviews examining the assessment, training, or implementation of NTS among healthcare professionals. The review protocol was registered with PROSPERO (CRD420251008161). Data were extracted and synthesized using a structured narrative synthesis, with explicit consideration of relevance and transferability to emergency department contexts. Results: A total of 2,229 records were identified, and 17 reviews published between 2012 and 2024 were included, with 88% originating from high-income countries. Key themes encompassed NTS conceptual frameworks, methodological approaches, assessment instruments, and outcome measures. Widely reported frameworks and tools included Crisis Resource Management, Trauma Non-Technical Skills (T-NOTECHS), and the Team Emergency Assessment Measure (TEAM). Evidence most consistently indicated improvements in team behaviors and process performance, predominantly in simulation-based or observational settings. No meta-analyses were identified. Conclusions: This umbrella review synthesizes review-level evidence on NTS assessment and training across healthcare and highlights considerations for application in emergency department practice. The evidence most consistently supports improvements in team behaviors and process performance, largely in simulation-based or observational settings, while direct evidence for effects on patient outcomes in routine ED care remains limited. Future research should prioritize multicentre, cross-cultural, and longitudinal designs with harmonized outcomes to better evaluate implementation, effectiveness, and contextual transferability to emergency department settings.