Improving Clinical Performance of an Interprofessional Emergency Medical Team through a One-day Crisis Resource Management Training

Open access

Abstract

Introduction: Errors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates.

The aim of the study: To assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team.

Material and Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.

Results: An improvement was seen in most of the measured clinical parameters.

Conclusion: Our study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.

1. Rovamo L, Nurmi E, Mattila MM, et al. Effect of a simulation-based workshop on the multidisciplinary teamwork of newborn emergencies: an interventional study. BMC Res Notes. 2015;8:671.

2. Hicks MC, Kiss A, Bandiera WG, et al. Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents. CJEM. 2012;14(6):354-62.

3. Petrosoniak A, Hicks CM. Beyond crisis resource management: new frontiers in human factors training for acute care medicine. Curr Opin Anesthesiol. 2013;26:699-706.

4. Rall M, Gaba D- Human Performance and Patient Safety. In Miller, RD (ed): Miller’s Anesthesia. Philadelphia: Elsevier Churchill Livingstone. 2005, pp. 3021-72.

5. Gaba D, Howard S, Fish K. Simulation-based training in anesthesia crisis resource management (ACRM): a decade of experience. Simul Gaming. 2001;32:175-93.

6. Morey JC, Simon R, Jay GD, et al. Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project. Health Serv Res. 2002;37(6):1553-81.

7. Chiniara G, Cole G, Brisbin K, et al. Simulation in healthcare: a taxonomy and a conceptual framework for instructional design and media selection. Med Teach. 2013;35(8):e1380-95.

8. Boet S, Bould MD, Fung L, et al. Transfer of learning and patient outcome in simulated crisis resource management: a systematic review. Can J Anesth. 2014;61:571-82.

9. Pucher PH, Aggarwal R, Batrick N, et al. Nontechnical skills performance and care processes in the management of the acute trauma patient. Surgery. 2014;155(5):902-9.

10. Flin R, O’Connor R, Crichton M. Safety at the Sharp End: A Guide to Nontechnical Skills. Farnham, UK: Ashgate; 2008.

11. Bleetman A, Sanusi S, Dale T, Brace S. Human factors and error prevention in emergency medicine. Emerg Med J. 2012;29:389-93.

12. Carne B, Kennedy M, Gray T. Crisis resource management in emergency medicine. Emerg Med Australas. 2012;24:7-13.

13. Simmons JW, Powell MF. Acute traumatic coagulopathy: pathophysiology and resuscitation. Br J Anaesth. 2016;117(3):iii31-iii43.

14. Wright MC, Phillips-Bute BG, Petrusa ER, Griffin KL, Hobbs GW, Taekman JM. Assessing teamwork in medical education and practice: relating behavioural teamwork ratings and clinical performance. Med Teach. 2009;31:30-8.

15. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric cardiopulmonary arrest survival rates. Pediatr Crit Care Med. 2011;12:33-8.

16. Steinemann S, Berg B, Skinner A et al. In situ-multidisciplinary, simulated-based teamwork training improves early trauma care. J Surg Educ. 2011;68:472-7.

17. Capella J, Smith S, Philp A et al. Teamwork training improves the clinical care of trauma patients. J Surg Educ. 2010;67:439-43.

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 276 276 50
PDF Downloads 90 90 9