Crisis Resource Management Principles Research Articles

Advanced clinicians’ experience of participation in an escape room scenario designed to consolidate crisis resource management principles: An exploratory pilot study

BackgroundIntensive care outreach nurses are required to work as part of an ad hoc team to review and manage patients who are deteriorating outside of critical care environments. Nontechnical skills, such as those encompassed by crisis resource management principles, are essential when working in these situations. Used commercially for entertainment, escape rooms have recently been utilised by clinical educators to teach both technical and nontechnical skills. ObjectiveThis exploratory study evaluates how advanced clinicians, intensive care outreach nurses, experience an escape room scenario designed to consolidate crisis resource management (CRM) principles. MethodsThree escape room sessions were conducted in a 1038-bed metropolitan tertiary referral hospital. A purposive sample of 12 intensive care outreach nurses were invited to participate. The participant's experience of the escape room scenario was determined by their responses to a post–escape room survey and focus group discussion. Transcripts of the audio recordings from focus group discussions were analysed using an inductive coding approach. ResultsTwo primary categories emerged from analysis of the focus group discussions: (i) the clinicians’ experiences of the escape room and (ii) CRM principles. The first category included descriptions of emotions, including confusion, frustration, and a dislike for puzzles. The second category included both the participants understanding of the CRM principles, and how the principles influence the work within the escape room. ConclusionsEscape rooms have shown promise as novel educational environments, which challenge participants. Despite initial negative descriptions of the escape room, focus group discussions demonstrated that the participants were able to recognise the impact of CRM principles and acknowledge how these affect their clinical work in an ad hoc team.

Improving patient's intensive care admission through multidisciplinary simulation-based crisis resource management: A qualitative study.

To explore nurses' and physicians' experiences of simulation-based training in a crisis resource management quality improvement intervention on intensive care admission. Quantitative studies have documented that staffs' non-technical skills are improved after simulation-based training in crisis resource management interventions. Experienced-based consensus led to development of a quality improvement intervention based on principles of crisis resource management and tested in simulation-based training to enhance staffs' non-technical skills. However, the impact on staff is unexplored, leaving little understanding of the relationship between simulation-based training in crisis resource management interventions and changes in non-technical skills. A qualitative study with a hermeneutical approach. Data consisted of semi-structured interviews with physicians (n = 5) and nurses (n = 15) with maximum variation in work experience. Data were collected 3 months after implementation and analysed using thematic analysis. The COREQ guideline was applied. The analysis revealed three themes: prioritising core clinical activities and patient centredness; transition into practice; and reflection on patient safety. These themes reflected staff's experiences of the intervention and implementation process, which evolved through prioritising core clinical activities that facilitated the transition into clinical practice and staff's reflection on patient safety. Prioritising core clinical activities were facilitated by clear communication, predefined roles and better teamwork. Transition into practice stimulated professional growth through feedback. Reflection on patient safety created a new understanding on how a new structure of intensive care admission could be implemented. Collectively, this indicated a joint understanding of admissions. Findings enables health care professionals to understand how the intervention can contribute to improve quality of care in management of intensive care admission. Improving non-technical skills are vital in high-quality admissions, which supported a structured process and a collaborative professional standard of admissions. None.

Non-technical skills in the operating room: Crisis resource management principles

Non-technical skills in the operating room: Crisis resource management principles - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2023.025, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

High-Fidelity Simulation-Based Education: Description of an Original Crisis Resource Management and Sedation Learning for Dental Surgeons.

Dental surgery includes invasive procedures performed under sedation or monitored anesthesia care (MAC). It is associated with respiratory risks, resulting in death or neurological sequelae without prompt and appropriate management. Management of airway complications also implies mastering crisis resource management (CRM) principles, essentially non-technical skills to improve patient safety. In response to the need to enhance patient safety and to securely perform surgical procedures outside the operating room due to reduced surgical activity during the worldwide spread of the COVID-19 pandemic, we realized, in our simulation center, a course based on high fidelity simulation to teach procedural sedation and management of related complications. The simulation center accredited this educational program as a continuing professional development formation. The course includes technical skills practice, theoretical presentation, and mastering non-technical skills related to CRM principles. This brief report describes a relatively innovative teaching technique in dentistry, highlights its interest, and reports the subjective opinion of learners as to the pedagogical and professional impact of this training. A learner’s satisfaction survey supports the utility of our sedation and CRM programs. A high degree of satisfaction and perceived value reflect robust learners’ engagement. All medical specialties should encourage high-fidelity simulation continuing professional development courses that incorporate technical skills and crisis management principles.

Evolution of clinical event debriefs in a quaternary pediatric emergency department after implementation of a debriefing tool.

Debriefing clinical events in the emergency department (ED) can enhance team performance and provide mutual support. However, ED debriefing remains infrequent and nonstandardized. A clinical tool (DISCERN-Debriefing In Situ Conversation after Emergent Resuscitation Now) was developed to facilitate ED debriefing. To date, there are no studies providing qualitative analysis of clinical event debriefs done using such a tool. Our goal was to explore common themes elicited by debriefing following implementation of DISCERN. This was a retrospective mixed-methods study analyzing DISCERN data from 2012 through 2017 in a pediatric ED. Quantitative data were analyzed using descriptive statistics. With constant comparison analysis, themes were categorized when applicable within the context of crisis resource management (CRM) principles, previously used as a framework for description of nontechnical skills. Member checking was performed to ensure trustworthiness. We reviewed 400 DISCERN forms. Overall, 170 (41.6%) of target clinical events were debriefed during the study period. The number of clinical events debriefed per year decreased significantly over the study period, from 118 debriefed events in 2013 to 20 debriefed events in 2017 (p<0.001). Events were more likely to be debriefed if cardiopulmonary resuscitation was needed (odds ratio [OR]=11.8, 95% confidence interval [CI]=4.1-33.8]) or if the patient expired (OR=8.9, 95% CI=2.7-29.1]). CRM principles accounted for 81% of debriefing statements, focusing on teamwork, communication, and preparation, and these themes remained consistent throughout the study period. Use of the DISCERN tool declined over the study period. The DISCERN tool was utilized more commonly after the highest-acuity events. Clinical event debriefs aligned with CRM principles, with medical knowledge discussed less frequently, and the content of debriefs remained stable over time.

Effects of using a cognitive aid on content and feasibility of debriefings of simulated emergencies.

Background: Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated.Methods: In a simulated night shift, seven teams of four to five medical students (n=32) took part in six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool – a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) – or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM).Results: The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants’ satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions.Conclusion: The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely.

Behavioral Crisis Management: A Quality Improvement Pilot for Improving Teamwork in a Primary Care Pediatric Setting

IntroductionChildren with behavioral escalations in the primary care office may pose safety risks to themselves and others. Interprofessional teams utilizing crisis resource management (CRM) skills more successfully manage behavioral crises. The purpose of this quality improvement (QI) pilot project was to improve team performance during a behavioral crisis in pediatric primary care, as well as evaluate learner satisfaction with the curriculum. MethodWe implemented an evidence-based curriculum using simulation and didactic techniques in primary care offices within a pediatric network. Using a one group pre-post design, we evaluated roles, communication, and patient-centered care with the KidSIM Team Performance Scale. Utilizing a post intervention survey, learner feedback was elicited regarding learning environment, facilitators and barriers to learning, skill of facilitator, and usability and applicability of content. Findings101 interprofessional participants attended one of eight educational sessions. KidSIM Team Performance Scale results demonstrated statistically significant improved total team performance in a simulated behavioral crisis (Z = −2.52, p = 0.012). Post simulation evaluation demonstrated positive feedback about the program, content and facilitators. DiscussionThis pilot QI project demonstrated that a curriculum using behavioral simulation scenarios and CRM principles can improve teamwork in an interprofessional primary care office. Additionally, participants overwhelmingly indicated satisfaction with the curriculum. Application to practiceEnsuring staff have the appropriate skills to manage behavioral health crises facilitates safer and more effective patient care, enhances patient-centered care and solidifies a positive staff approach in the pediatric ambulatory setting.

Adhering to Social Distancing Rules Using a "Split Patient" Model With Rapid Cycle Deliberate Practice in Pediatric High-Fidelity Simulations.

The coronavirus disease 2019 (COVID-19) pandemic has required simulation-based medical education to adapt to physical distancing regulations in order to protect learners and facilitators. The “split patient” model allows for physical distancing of learners in pediatric high-fidelity simulations. This model was able to be used with the Rapid Cycle Deliberate Practice to teach pediatric residents basic and advanced life support skills and the principles of Crisis Resource Management.

In situ interprofessional operating room simulations: Empowering learners in crisis resource management principles

BackgroundGiven the multifaceted nature of operating room teams, miscommunication at various perioperative stages leads to lapses in teamwork and communication, which potentiates adverse events. In situ interprofessional operating room simulations are a valuable tool in identifying the possible threats to patient safety in the operating room. Participant confidence may also increase; however, perceived confidence in specific areas of team communication in the clinical environment remains unclear. This research aims to study how in situ interprofessional operating room simulations increase participants’ individual confidence in 4 team principles derived from crisis resource management: using effective communication, utilizing resources, establishing role clarity, and using effective situational awareness. MethodsOver a 2-year period, interdisciplinary operating room team members were assigned to participate in 13 simulated surgical case scenarios, which were chosen based on the volunteer surgeon’s specialty. These cases were designed to engage all team members and included a crisis scenario (ie, hemorrhage, airway emergency, arrhythmia, or cardiac arrest). All statistical analyses were performed using RStudio version 1.2.1335 software. We analyzed matched pre- and postsimulation self-assessment of individual confidence using the Wilcoxon signed-rank test for each of the 4 aforementioned constructs of interest derived from crisis resource management training principles. Significance was set at P < .0038, using Bonferroni correction, for all comparisons to account for the multiple comparisons problem. ResultsThere was a statistically significant shift in the 4-point scale toward greater self-reported confidence from presimulation to postsimulation for each of the 4 team principles: using effective communication (P = .0019, r = 0.18), utilizing resources well (P = .0014, r = 0.18), establishing role clarity (P < .0010, r = 0.22), and using effective situational awareness (P < .0010, r = 0.27). ConclusionIn this pilot study, we describe how teaching crisis resource management principles in an in situ operative simulation is an effective way to increase the confidence of communication skills among the members of an interdisciplinary procedure/operative team during crisis scenarios. In situ simulation can be used to evaluate system competence and interdisciplinary dynamics, and to identify latent conditions that predispose to medical error. As we continue to conduct these sessions, we aim to evaluate their impact on individual confidence and the advancement of interdisciplinary efforts to improve patient care.

The Need for Purposeful Teaching, Learning and Assessment of Crisis Resource Management Principles and Practices in the Undergraduate Pre-Hospital Emergency Care Curriculum: A Narrative Literature Review

Introduction Traditionally, undergraduate emergency medical care (EMC) training programs have, over the years, typically focussed on developing individuals with proficiency in clinical skills who can perform complex procedures in the act of administering safe and effective emergency care in the pre-hospital setting. A shortcoming of this training relates to the attention given to the soft skills needed to work efficiently in a team-based environment. Crisis resource management (CRM) is a structured, evidence-based approach to training that is designed to enhance teamwork performance in critical circumstances where the absence of coordinated teamwork could lead to undesired outcomes. Methods A narrative review of GOOGLE SCHOLAR, MEDLINE, PUBMED, CINAHL as well as paramedic-specific journals was conducted. Articles were included if they examined the importance of CRM in pre-hospital emergency care; training undergraduate pre-hospital emergency care students on the principles and practices of CRM; and non-technical skills in pre-hospital emergency care. Discussion Researchers found limited articles related to CRM and the pre-hospital emergency care setting. Our findings reveal that CRM focusses on addressing non-technical skills necessary for effective teamwork and that those identified to be relevant for effective teamwork in pre-hospital emergency care setting include situation awareness, decision-making, verbal communication, teamwork as well as leadership and followership skills. Conclusion Effective team management is a core element of expert practice in emergency medicine. When practised in conjunction with medical and technical expertise, CRM can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of a pre-hospital emergency care plan.

High Altitude Pulmonary Edema.

This simulation was developed to educate emergency medicine residents on the diagnosis and management of high-altitude pulmonary edema (HAPE). This case is also appropriate for senior medical students and advanced practice providers. The principles of crisis resource management, teamwork, and communication are incorporated into the case. High altitude pulmonary edema may present similarly to pneumonia with nonspecific symptoms, including decreased exercise tolerance, cough, dyspnea with exertion, and fever. Symptoms more specific to HAPE include dyspnea at rest, tachypnea, history of rapid ascent to high altitude, a lowlander patient exposed to high-altitude, or a highlander patient on re-entrance to high altitude after lowland stay. Laboratory and imaging workup may include infiltrates on chest x-ray and leukocytosis.1,2 Of the various forms of altitude sickness, HAPE has the highest fatality rate, estimated at 50% in travellers to the Himalayas who are unable to descend.1 Providers should inquire as to the current elevation of their facility, the patient's recent altitude gain, and the rate of ascent. Treatment priorities include oxygen and immediate descent, as well as supplemental treatment with nifedipine and phosphodiesterase (PDE) inhibitors such as sildenafil or tadalafil. At the conclusion of the simulation session, learners will be able to:obtain a thorough history relevant to altitude illnessesdevelop a differential for dyspnea in a patient with environmental exposuresdiscuss prophylaxis and management of HAPEdiscuss appropriate disposition of the patient including descent and subsequent appropriate level of care. This session was conducted using high-fidelity simulation followed by a debriefing session and lecture on the diagnosis and management of HAPE. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This technique includes an observation statement, a statement describing the framework of the observer, and an invitation to review further to explore the participants' frames. An example of this advocacy-inquiry is as follows: "I heard Sam suggest to the team that acetazolamide be given, but then I didn't hear any follow-up discussion. Acetazolamide is often utilized for acute mountain illness prophylaxis or treatment. I wasn't sure if the team did not hear his suggestion or disagreed with the treatment plan. Tell me more." This scenario was designed as a simulation, but it could be adapted as an oral boards case. Our residents were provided with a survey at the completion of the simulation and debriefing to rate different aspects of the simulation, as well as to provide qualitative feedback. Participants expressed positive feedback, with comments focused on appreciating the review of the presentation, diagnosis, and treatment of altitude illness. The emergency medicine residents surveyed currently practice in a low altitude setting and were appreciative to simulate a scenario to which they might otherwise not get exposure during their residency. Our simulation center's feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form. This session received all 6 or 7 scores (consistently effective/very good or extremely effective/outstanding) other than a 5 for setting the stage, a 4 for maintaining an engaging context for learning, and two 5s for structured debriefing. This was an effective method to review high altitude illness with learners that may otherwise get limited exposure to such clinical cases during residency. Learners had a broad range of differential diagnoses and demonstrated variable levels of knowledge related to the diagnosis and treatment of high-altitude illness. We used visual stimuli and a reminder from our nurse to reinforce for the learners that the case was taking place at a critical access emergency room at 11,000 feet of elevation. Medical simulation, high altitude pulmonary edema, high altitude cerebral edema, altitude sickness, emergency medicine, wilderness medicine.

Multidisciplinary Simulation-Based Team Training: Knowledge Acquisition and Shifting Perception

BackgroundA multidisciplinary simulation-based team training workshop was implemented to improve the knowledge and application of crisis resource management (CRM) principles in the pediatric cardiac intensive care unit. MethodsThe workshop consisted of two scenarios followed by structured debriefing. The participants were asked to complete a survey, before and three months after the workshop, evaluating the knowledge base of CRM principles and perception of team dynamics. ResultsThe initial survey was completed by 144 participants; the follow-up was completed by 72 participants. There was a significant knowledge gap before the workshop, particularly in the areas of closed-loop communication and key principles for effective communication, which improved after the workshop. There was improvement in the perception of team performance three months after the workshop. ConclusionsThis study shows that a multidisciplinary simulation-based team training in the pediatric cardiac intensive care unit improves knowledge of CRM principles in addition to improved perception of effective teamwork.

MP24: The University of Ottawa's Department of Emergency Medicine pre-internship boot camp: a descriptive review

Innovation Concept: Emergency Medicine (EM) residency programs in Canada have transitioned to competency based medical education and the first stage of the curriculum focuses on standardizing learner competency. Pre-internship boot camps provide a focused opportunity to assist with this standardization prior to residency training. The objective of this descriptive review was to describe our institution's EM pre-internship boot camp in the context of current literature and to summarize the state of EM boot camp curricula across all reported EM residency programs. Methods: The description of our two-day boot camp included its curriculum design, required preparation and resources, and a detailed timeline of each day's events. To compare our boot camp to current literature, a comprehensive search of both primary and gray literature was performed. Curriculum, Tool or Material: Our institution's boot camp is two days of teaching focused on clinical knowledge and procedural competency, with a large component centered on simulation. Day one consisted of an introduction to the boot camp, a review of crisis resource management principles and advanced cardiac life support (ACLS) algorithms, ACLS simulation sessions, and small group skill sessions on common emergency department procedures. Day two contained a point of care ultra sound lecture, an ultrasound guided central venous catheterization session, pigtail and chest tube insertion sessions, and high-fidelity simulation cases. In comparison to the other pre-internship boot camps that were identified in the literature, our boot camp offers a unique focus and format. Conclusion: This review is the first to report on an EM-specific boot camp at a non-American institution, and it provides a framework for the development and refinement of pre-internship EM boot camps at other universities.

Quality improvement and crisis resource management in pediatric resuscitation.

The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change. Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation. Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.

“SIMBurns”: A high-fidelity simulation program in emergency burn management developed through international collaboration

Acute management of a severely burned patient is an infrequent and stressful situation that requires medical knowledge as well as immediate coordinated action. Many adverse events in health care result from issues related to the application of ‘non-technical' skills such as communication, teamwork, leadership and decision making rather than lack of medical knowledge. Training in these skills is known as Crisis Resource Management (CRM) training.In order to create well-prepared burn teams, it is critical to teach CRM principles through high-fidelity simulation (HFS).While CRM teaches foundational non-technical skills, HFS incorporates lifelike, whole-body, fully-responsive mannequins in order to provide a realistic emergency situation.The aim of the study is to describe the development of a novel high-fidelity simulation course called “SIMBurns: High Fidelity Simulation Program for Emergency Burn Management” that uses CRM as its foundation and is focused on management of burn injuries. The course was designed by a panel of simulation and burns experts from Meyer Children’s Hospital in Italy and Birmingham Children’s Hospital in the U.K. Simulation Program experts were certified by Boston Children’s Hospital’s Simulation Program. In this paper, we describe the course’s design, development, structure, and participant’s assessment of the course. Since the creation of the SIMBurns course in 2013, 9 courses have been conducted and 101 participants have attended the course. The course was well-received and its “Overall Satisfaction” was rated at 4.8/5. The primary objective in the SIMBurns course – to teach teamwork and CRM skills to medical staff involved in emergency burn care – was also met at 4.8/5. Participants felt that the course developed their ability to interact with other team members, further improved their understanding of how to appropriately use resources, emphasized the importance of role clarity and developed their communication skills. Additional quantitative and qualitative analyses obtained from participants were also reviewed after each course. The SIMBurns course aims to contribute to the education of those in healthcare in order to improve patient safety and to continue advancing the education of our emergency burn care teams.

Non-technical skills assessment scale in nursing: construction, development and validation

ABSTRACTThe introduction of non-technical skills during nursing education is crucial to prepare nurses for the clinical context and increase patient safety. We found no instrument developed for this purpose. Objectives:to construct, develop and validate a non-technical skills assessment scale in nursing. Method:methodological research. Based on the literature review and experience of researchers on non-technical skills in healthcare and the knowledge of the principles of crisis resource management, a list of 63 items with a five-point Likert scale was constructed. The scale was applied to 177 nursing undergraduate students. Descriptive statistics, correlations, internal consistency analysis and exploratory factor analysis were performed to evaluate the psychometric properties of the scale. Results:scale items presented similar values for mean and median. The maximum and the minimum values presented a good distribution amongst all response options. Most items presented a significant and positive relationship. Cronbach alpha presented a good value (0.94), and most correlations were significant and positive. Exploratory factor analysis using the Kaiser-Meyer-Olkin test showed a value of 0.849, and the Bartlett’s test showed adequate sphericity values (χ2=6483.998; p=0.000). One-factor model explained 26% of the total variance. Conclusion:non-technical skills training and its measurement could be included in undergraduate or postgraduate courses in healthcare professions, or even be used to ascertain needs and improvements in healthcare contexts.

Impact of a One Day Crisis Resource Management Training on the Work Satisfaction among Emergency Department Healthcare Staff

Abstract Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks. Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.

Simulation-based Crisis Resource Management in Pharmacy Education

Objective. To describe strategies for implementation of simulation-based crisis resource management (CRM) in pharmacy education and present students' appreciation of an interdisciplinary CRM training at a university in Canada. Methods. In fall 2016, third-year undergraduate pharmacy students at Laval University and pharmacy technician students from Fierbourg school participated in a CRM activity and completed a five-item survey to assess the quality of the CRM activity they had just experienced. Paired t-tests were computed to detect differences of appreciation between pharmacy technician students and pharmacy students. Results. Students rated each item as very good or excellent varying from 81% to 97%. The only difference found between the two types of students was on their overall appreciation of the experience. Pharmacy technician students rated their experience as very good while pharmacy students rated it as excellent. Conclusion. CRM training can easily be adapted to the context of pharmacy education because its key concepts of team management, resource allocation, awareness of environment and dynamic decision-making directly apply to pharmacy practice. Based on the results of this study, students greatly value their CRM training experience. Future research is needed to measure the transfer into practice of CRM principles.

Development of a Multiple-Choice Test for Novice Anesthesia Residents to Evaluate Knowledge Related to Management of General Anesthesia for Urgent Cesarean Delivery

Teaching trainees the knowledge and skills to perform general anesthesia (GA) for cesarean delivery (CD) requires innovative strategies, as they may never manage such cases in training. We used a multistage design process to create a criterion-referenced multiple-choice test as an assessment tool to evaluate CA1's knowledge related to this scenario. Three faculty created 33 questions, categorized as: (1) physiologic changes of pregnancy (PCP), (2) pharmacology (PHA), (3) anesthetic implications of pregnancy (AIP), and (4) crisis resource management principles (CRM). A Delphi process (3 rounds) provided content validation. In round 1, experts (n = 15) ranked questions on a 7-point Likert scale. Questions ranked ≥ 5 in importance by ≥ 70% of experts were retained. Five questions were eliminated, several were revised, and 1 added. In round 2, consensus (N = 14) was reached in all except 7 questions. In round 3 (N = 14), all questions stabilized. A pilot test of the 29-question instrument evaluating internal consistency, reliability, convergent validity, and item analysis was conducted with the July CA1 classes at our institution after a lecture on GA for CD (n = 26, "instructed group") and another institution with no lecture (n = 26, "uninstructed group"), CA2s (N = 17), and attendings (N = 10). Acceptable internal consistency and reliability was demonstrated (ρ = 0.67). Convergent validity coefficients between the CA1 uninstructed and instructed group suggested theoretical meaningfulness of the 4 sub-scales: PCP correlated at 0.29 with PHA, 0.35 with CRM, and 0.25 with AIP. PHA correlated with CRM and AIP at 0.23 and 0.28, respectively. The correlation between CRM and AIP was 0.29. The test produces moderately reliable scores to assess CA1s' knowledge related to GA for urgent CD.

Acute Hemolytic Transfusion Reaction

Author(s): Purcell, Michael; San Miguel, Christopher; Yee, Jennifer | Abstract: ABSTRACT: Audience: This scenario was developed to educate emergency medicine residents on the diagnosis and management of acute hemolytic transfusion reactions in the emergency department. The case is appropriate for senior medical students and advanced practice providers. The principles of crisis resource management, teamwork, and communication are also incorporated into the case. Introduction: Patients who present with suspected acute hemolytic transfusion reactions require rapid diagnosis and management, as well as a thorough evaluation for other differential diagnoses, such as DIC (disseminated intravascular coagulation), TTP (thrombotic thrombocytopenic purpura), and sepsis. The possibility of acute hemolytic transfusion must be entertained early, as it carries significant morbidity including the risk of developing acute hemolytic anemia, acute renal failure, DIC, shock, and/or death.1 The mortality rate of acute hemolytic transfusion reactions can reach 44%, and it accounts for 20% of all transfusion-related mortalities.2,3 Given this significant morbidity and mortality, early recognition and management are paramount in the emergency department (ED) to avoid clinical deterioration and death. Objectives: By the end of this simulation session, the learner will be able to: 1) Recognize the clinical signs and symptoms associated with transfusion reactions. 2) Discuss necessary systems-based management of potential transfusion reactions, such as notifying the blood bank and evaluating to see if another patienta accidentally received a wrong unit of blood. 3) Discuss the management of various transfusion reactions. 4) Appropriately disposition the patient to an intensive care unit (ICU) or stepdown unit. 5) Effectively communicate with team members and nursing staff during the resuscitation of a critically ill patient. Method: This session is conducted using high-fidelity simulation, followed by a debriefing session and lecture on the diagnosis and management of transfusion reactions. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. Topics: Medical simulation, acute hemolytic transfusion reaction, transfusion reactions, hematology, emergency medicine.