Hostname: page-component-7479d7b7d-wxhwt Total loading time: 0 Render date: 2024-07-10T23:30:26.491Z Has data issue: false hasContentIssue false
  • English
  • Français

Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents

Published online by Cambridge University Press:  11 May 2015

Christopher M. Hicks ,
Alex Kiss ,
Glen W. Bandiera  and
Christopher J. Denny
Christopher M. Hicks*
Affiliation:
Division of Emergency Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON
Alex Kiss
Affiliation:
Institute for Clinical and Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON
Glen W. Bandiera
Affiliation:
Division of Emergency Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON
Christopher J. Denny
Affiliation:
Division of Emergency Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON
*
Division of Emergency Medicine, University of Toronto, St. Michael's Hospital, 1-008e Shuter Wing, 30 Bond Street, Toronto, ON M5B 1W8; christopher.hicks@utoronto.ca.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviationbased crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of “Crisis Resources for Emergency Workers” (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents.

Methods:

Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS).

Results:

Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved teambased attitudes as assessed by the HFAS (p = 0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p = 0.16).

Conclusions:

EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

Keywords

crisis resource managementmedical educationpatient safety
Type
Education • Enseignement
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 6 , November 2012 , pp. 354 - 362
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

REFERENCES

1.Croskerry, P. Cognitive forcing strategies in clinical decisionmaking. Ann Emerg Med 2003;41:110–20, doi:10.1067/mem.2003.22.CrossRefGoogle ScholarPubMed
2.Chisholm, C, Collison, E, Nelson, D, et al. Emergency department workplace interruptions: are emergency physicians “interruption-driven” or “multitasking”? Acad Emerg Med 2000;7:1239–43, doi:10.1111/j.1553-2712.2000.tb00469.x.CrossRefGoogle ScholarPubMed
3.Kohn, L, Corrigan, J, Donaldson, JE. To err is human: building a safer health system. Washington (DC): National Academy Press; 1999.Google Scholar
4.Williamson, J, Webb, R, Sellen, A, et al. Human failure: an analysis of 2000 incident reports. Anesth Intensive Care 1993;21:678–83.Google Scholar
5.LeBlanc, V. The effects of acute stress on performance: implications for health professions education. Acad Med 2009;84(10 Suppl):S25–33, doi:10.1097/ACM.0b013e3181b37b8f.CrossRefGoogle ScholarPubMed
6.Driskell, J, Salas, E. Does stress lead to a loss of team perspective? Group Dynamics 1999;3:291–302, doi:10.1037/1089-2699.3.4.291.Google Scholar
7.Driskell, J, Salas, E. Group decision making under stress. J Appl Psychol 1991;76:473–8, doi:10.1037/0021-9010.76.3.473.Google Scholar
8.Gaba, D, Howard, S, Fish, K. Crisis management in anesthesiology. New York: Churchill Livingstone Publishers; 1994.Google Scholar
9.Helmreich, R. On error management: lessons from aviation. BMJ 2000;320:781–5, doi:10.1136/bmj.320.7237.781.CrossRefGoogle ScholarPubMed
10.Ziv, A, Wolpe, P, Small, S, et al. Simulation-based medical education: an ethical imperative. Acad Med 2003;78:783“8, doi:10.1097/00001888-200308000-00006.Google Scholar
11.Ericsson, K, Krampe, R, Tesch-Romer, C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100:363–406, doi:10.1037/0033-295X.100.3.363.CrossRefGoogle Scholar
12.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, doi:10.1177/104687810103200206.CrossRefGoogle Scholar
13.Hunt, E, Shilkofski, N, Stavroudis, T, et al. Simulation: translation to improved team performance. Anesthesiol Clin 2007;25:301–19, doi:10.1016/j.anclin.2007.03.004.Google Scholar
14.Reznek, M, Smith-Coggins, R, Howard, S, et al. Emergency Medicine Crisis Resource Management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Acad Emerg Med 2003;10:386–9, doi:10.1111/j.1553-2712.2003.tb01354.x.Google Scholar
15.Burke, C, Salas, E, Wilson-Donnelly, K, et al. How to turn a team of experts into an exert medical team: guidance from the aviation and military communities. Qual Saf Health Care 2004;13:96–104, doi:10.1136/qshc.2004.009829.CrossRefGoogle Scholar
16.Kirkpatrick, D. Evaluation of training In: Craig, R, editor. Training and development handbook: a guide to human resources development. New York: McGraw-Hill; 1976. p. 18.1–.27.Google Scholar
17.Salas, E, Burke, S, Bowers, C, et al. Team training in the skies: does crew resource management (CRM) training work? Hum Factors 2001;43:641–74, doi:10.1518/001872001775870386.Google Scholar
18.Hicks, C, Bandiera, G, Denny, C. Building a crisis resource management course for emergency medicine, phase 1: results from an interdisciplinary needs assessment survey. Acad Emerg Med 2008;15:1136–43, doi:10.1111/j.1553-2712.2008.00185.x.Google Scholar
19.TuPASS scenario script. 2008. Available at: http://www.tupass.de/downloads/TuPASS_Scenario_Script.doc (accessed July 20, 2008).Google Scholar
20.Society for Acacemic Emergency Medicine (SAEM) simulation case library. 2007. Available at: http://www.emedu.org/(X(1)S(h0e1b345v53cwqigtmcvew55))/simlibrary/default.aspx?AspxAutoDetectCookieSupport=1 (accessed July 20, 2008).Google Scholar
21.Grogan, E, Styles, R, France, D, et al. The impact of aviationbased teamwork training on the attitudes of health care professionals. J Am Coll Surg 2004;199:843–8, doi:10.1016/j.jamcollsurg.2004.08.021.CrossRefGoogle ScholarPubMed
22.Kim, J, Neilipovitz, D, Cardinal, P, et al. A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, And Crisis Resource Management I Study. Crit Care Med 2006;34:2167–74, doi:10.1097/01.CCM.0000229877.45125.CC.Google Scholar
23.Shrout, P, Fleiss, J. Interclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86:420–8, doi:10.1037/0033-2909.86.2.420.CrossRefGoogle Scholar
24.Helmreich, R, Merritt, A, Wilhelm, J. The evolution of crew resource management training in commerical aviation. Int J Aviat Psychol 1999;9:19–32, doi:10.1207/s15327108ijap0901_2.Google Scholar
25.Morey, J, Simon, R, Jay, G, 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;37:373–83, doi:10.1111/1475-6773.01104.CrossRefGoogle ScholarPubMed
26.Shapiro, M, Morey, J, Small, S, et al. Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Qual Saf Health Care 2004;13:417–21, doi:10.1136/qshc.2003.005447.CrossRefGoogle Scholar
27.Royal College of Physicians and Surgeons of Canada. About CanMEDS. Available at: http://rcpsc.medical.org/canmeds/about_e.php (accessed March 1, 2008).Google Scholar
28.Fanning, R, Gaba, D. The role of debriefing in simulationbased learning. Simul Healthc 2007;2:115–25, doi:10.1097/SIH.0b013e3180315539.CrossRefGoogle ScholarPubMed
29.Salvodelli, G, Naik, V, Park, J, et al. Value of debriefing during simulated crisis management: oral versus videoassisted oral feedback. Anesthesiology 2006;105:279–85, doi:10.1097/00000542-200608000-00010.Google Scholar
30.Malec, J, Torsher, L, Dunn, W, et al. The Mayo High Performance Teamwork Scale: reliability and validity for evaluating key crew resource management skills. Simul Healthc 2007;2:4–10, doi:10.1097/SIH.0b013e31802b68ee.CrossRefGoogle ScholarPubMed