Called Crew Resource Management Research Articles

Non-technical skills and teamwork in trauma: from the emergency department to the operating room.

Management of a trauma patient is a challenging process. Swift and accurate clinical assessment is required and time-sensitive decisions and life-saving procedures must be performed in an unstable patient. This requires a coordinated response by both the emergency room (ER) and operating room (OR) teams. However, a team of experts does not necessarily make an expert team. Root cause analysis of adverse events in surgery has shown that failures in coordination, planning, task management and particularly communication are the main causes for medical errors. While most research is focused on the ER trauma team, the trauma OR team also deserves attention. In fact, OR team dynamics may resemble more the ER team than the elective OR team. ER and OR trauma teams assemble on short notice, and their members, who are from different specialties and backgrounds, may not train regularly together or even know each other beforehand. And yet, they have to perform high-risk procedures and make high stake decisions, in a time-sensitive manner. The airline industry has long recognized the role of team training and non-technical skills (NTS) in reducing hazards. The implementation of the so called crew resource management or crisis resource management (CRM) has significantly made airline travel safer and the transposition to the medical context, with specific training in non-technical skills, has also brought great benefits. In fact, it is clear that adoption of non-technical skills (NTS) in healthcare has led to an increase in patient safety. In this narrative review we recapitulate some of the key non-technical skills and their relevance in trauma, with a focus on both the emergency department (ER) and the operating room (OR) teams, as well as on the transition of care from one to the other. Also, we explore the use of debriefing the team, as well as the roles of NTS training in both undergraduate and postgraduate settings. We review some of the existing trauma training courses and their roles in developing NTS. Finally, we briefly address the challenges posed by the development of trauma hybrid operating rooms.

Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine.

The Institute of Medicine has suggested that training in team behavior, leadership, communication, and other human factors could reduce medical errors and improve patient safety. Training on such topics has been adapted from teamwork training programs used in military and commercial aviation, called crew resource management (CRM). The principles behind CRM programs have been deployed in a number of clinical settings over the past 2 decades, and there are now several CRM vendors. Little is known about this nascent industry, and the emerging research supporting CRM programs lacks standardization and conclusive evidence. The objectives of this study were to report on the body of empirical data about CRM training in clinical settings and to provide a conceptual framework for evaluating its effectiveness in medicine. Using the proposed conceptual framework, the authors further examine currently published methods of measuring effectiveness and identify future directions for the use of teamwork training in medicine.

Basic concepts for crew resource management and non-technical skills.

In this paper, we explain the conceptual background to non-technical skills and show how they can influence job performance in anaesthesia. We then describe the taxonomy of anaesthetists' non-technical skills (ANTS) and related systems, such as ANTS-AP for anaesthetic practitioners. We discuss the training courses that have been designed to teach these non-technical skills, which are called crew resource management (CRM), crisis resource management (CRM) or crisis avoidance resource management (CARMA). Finally, we discuss the application of non-technical skills assessment systems.

Improving patient safety in the radiation oncology setting through crew resource management

PurposeThis paper demonstrates how the communication patterns and protocol rigors of a methodology called crew resource management (CRM) can be adapted to a radiation oncology environment to create a culture of patient safety. CRM training was introduced to our comprehensive radiation oncology department in the autumn of 2009. With 34 full-time equivalent staff, we see 100-125 patients daily on 2 hospital campuses. We were assisted by a consulting group with considerable experience in helping hospitals incorporate CRM principles and practices. Implementation steps included developing change initiative skills for key leaders, providing training in teamwork and communications, creating site-specific tools for safety and efficiency, and collecting data to document results. Methods and materialsOur goals were to improve patient safety, teamwork, communication, and efficiency through the use of tools we developed that emphasized teamwork and communication, cross-checking, and routinizing specific protocols. Our CRM plan relies on the following 4 pillars: patient identification methods; “pause for the cause”; enabling all staff to halt treatment and question decisions; and daily morning meetings. We discuss some of the hurdles to change we encountered. ResultsOur safety record has improved. Our near-miss rate before CRM implementation averaged 11 per month; our near-miss rate currently averages 1.2 per month. In the 5 years prior to CRM implementation, we experienced 1 treatment deviation per year, although none rose to the level of “mis-administration.” Since implementing CRM, our current patient treatment setup and delivery process has eliminated all treatment deviations. Our practices have identified situations where ambiguity or conflicting documentation could have resulted in inappropriate treatment or treatment inefficiencies. Our staff members have developed an extraordinary sense of teamwork combined with a high degree of personal responsibility to assure patient safety and have spoken up when they considered something potentially unsafe. We have increased our efficiency (and profitability); in 2012, our units of service were up 11.3% over 2009 levels with the same staffing level. ConclusionsThe rigor and standardization introduced into our practice, combined with the increase in communication and teamwork have improved both safety and efficiency while improving both staff and patient satisfaction. CRM principles are highly adaptable and applicable to the radiation oncology setting.

Improving Patient Safety in the Radiation Oncology Setting Through Crew Resource Management

Our purpose was to demonstrate how the communication patterns and protocol rigors of a methodology called Crew Resource Management (CRM) can be adapted to a radiation oncology environment to create a culture of patient safety. The principles of CRM, developed in high-risk/high-reliability industries, include training and teamwork, communication, and the routine usage of checklists and protocols. In recent years, CRM has been introduced to hospitals to focus on patient safety. CRM was introduced to our comprehensive radiation oncology department in the autumn of 2009. With 34 full-time equivalent staff, we see 85-100 patients daily on two hospital campuses. We were assisted by a consulting group with considerable experience in helping hospitals incorporate CRM practices. Our goals were to improve patient safety, teamwork, communication, and efficiency through the use of tools we developed that emphasized teamwork, cross-checking, and standardizing specific protocols. Our safety record has improved. In the 5 years prior to CRM implementation, we experienced one treatment deviation per year. Since implementing CRM, none of our treatments have deviated from the treatment plan. We have identified situations where conflicting documentation could have resulted in inappropriate treatment or significant patient harm. Staff members have developed an extraordinary sense of teamwork combined with a high degree of personal responsibility to assure patient safety. Staff members routinely speak-up when they consider something potentially unsafe. MD and Staff satisfaction scores are up (several measures). We have increased our efficiency (and profitability) at the same time we have enhanced patient safety and eliminated adverse events: in 2012 our units of service were up 11% over 2011 levels with the same staffing level. The rigor and standardization introduced into our practice, combined with the increase in communication and teamwork, have improved both safety and efficiency while improving both staff and patient satisfaction. CRM principles are highly adaptable and applicable to the radiation oncology setting.

Crew resource management in the ICU: the need for culture change.

Intensive care frequently results in unintentional harm to patients and statistics don’t seem to improve. The ICU environment is especially unforgiving for mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients. Human factors account for the majority of adverse events and a sound safety climate is therefore essential. This article reviews the existing literature on aviation-derived training called Crew Resource Management (CRM) and discusses its application in critical care medicine. CRM focuses on teamwork, threat and error management and blame free discussion of human mistakes. Though evidence is still scarce, the authors consider CRM to be a promising tool for culture change in the ICU setting, if supported by leadership and well-designed follow-up.

Critique and Proposed Revision of Crew Resource Management (CRM)

It is well over 30 years since the first (then called) cockpit resource management (CRM) training, now called crew resource management was introduced. It is a shibboleth, a sacred cow as it were, despite many issues, concerns, and changes over the years. Some 20 years ago, 1992, an Air Transport Association (ATA)/Federal Aviation Association (FAA)-sponsored Workshop was convened in an attempt to deal with some specific CRM issues. Yet the issues and needs as articulated in Workshop, and some newer ones, remain. Thus, this Chapter is 20 years overdue, leading to the questions: why now and is it still relevant? Why now? As said, some needs, issues, concerns remain. The relevancy is that we present both a critique of civil aviation CRM on many levels and a look/comparison with current USAF, USCG, and USN CRM. The authors include a proposed skeleton/template for a long-overdue revision of civil aviation CRM.

Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine

The Institute of Medicine has suggested that training in team behavior, leadership, communication, and other human factors could reduce medical errors and improve patient safety. Training on such topics has been adapted from teamwork training programs used in military and commercial aviation, called crew resource management (CRM). The principles behind CRM programs have been deployed in a number of clinical settings over the past 2 decades, and there are now several CRM vendors. Little is known about this nascent industry, and the emerging research supporting CRM programs lacks standardization and conclusive evidence. The objectives of this study were to report on the body of empirical data about CRM training in clinical settings and to provide a conceptual framework for evaluating its effectiveness in medicine. Using the proposed conceptual framework, the authors further examine currently published methods of measuring effectiveness and identify future directions for the use of teamwork training in medicine.

Crew Resource Management

Healthcare organizations continue their struggle to establish a culture of open communication and collaboration. Lessons are learned from the aviation industry, which long ago acknowledged that most errors were the result of poor communication and coordination rather than individual mistakes. The author presents a review of how some healthcare organizations have successfully adopted aviation's curriculum called Crew Resource Management, which promotes and reinforces the conscious, learned team behaviors of cooperation, coordination, and sharing.

Crew Resource Management training for offshore oil production teams

This paper describes a project to adapt a form of human factors training designed to improve safety called Crew Resource Management (CRM), which is widely used in aviation, to the training of offshore oil platform teams. The aim of the project was to design, deliver, and evaluate an offshore CRM training course. A total of 77 offshore workers from three different North Sea production platforms attended the courses. Their feedback was generally positive indicating that CRM training can be adapted for this industrial sector. There was some evidence of a change in attitudes towards decision making and personal limitations. However, there is a need to develop sensitive evaluation measures to be able to draw more conclusive evidence of the effects of CRM training on safety performance.

Advanced Qualification Training: A Study Of Implementation of Crm into Airline Training

The emphasis in training pilots on today's aircraft is placed on preparing the crew to interact with each other and to recognize any problem that may occur long before such a problem becomes a flight hazard. The training that is necessary to do this is called Crew Resource Management (CRM). Although CRM has been used by the airlines for about the past ten years, no integrated training among the airlines has been formulated until recently. Recent pressure from outside sources has prompted the FAA to initiate action to formalize CRM training in the airlines. The Federal Aviation Administration (FAA) established Special Federal Aviation Regulation (SFAR) 58, which created the Advanced Qualification Program (AQP) (Federal Aviation Administration, 1990). This allowed the airlines to develop their own training program which incorporates CRM and Line Operational Simulations (LOS). LOS utilizes simulator training using a typical operational passenger flight scenario, in a controlled training environment. It is designed to improve cockpit/cabin communication and coordination skills, and pilot decisionmaking skills (Federal Aviation Administration, 1995).

Crew resource management for teams in the offshore oil industry

The international aviation industry uses a special form of human factors training with their flight deck crews and other teams, called crew resource management (CRM). CRM is designed by psychologists and pilots to reduce errors and accidents and to improve emergency response capability by improving teamwork skills. Key topics include communication, decision making, assertiveness and stress management. CRM courses are now being used in shipping, medicine and the nuclear power industry. Follows an outline of CRM and describes an application in the offshore oil industry with control room operators and emergency command teams.