ObjectivesCrew resource management (CRM) training formats have become a popular method to increase patient safety by consideration of the role that human factors play in healthcare delivery. The purposes of this review were to identify what is subsumed under the label of CRM in a healthcare context and to determine how such training is delivered and evaluated.DesignSystematic review of published literature.Data sourcesPubMed, PsycINFO and ERIC were searched through 8 October 2018.Eligibility criteria for selecting studiesIndividually constructed interventions for healthcare staff that were labelled as CRM training, or described as based on CRM principles or on aviation-derived human factors training. Only studies reporting both an intervention and results were included.Data extraction and synthesisThe studies were examined and coded for relevant passages. Characteristics regarding intervention design, training conditions and evaluation methods were analysed and summarised both qualitatively and quantitatively.ResultsSixty-one interventions were included. 48% did not explain any keyword of their CRM intervention to a reproducible detail. Operating room teams and surgery, emergency medicine, intensive care unit staff and anaesthesiology came in contact most with a majority of the CRM interventions delivered in a 1-day or half-day format. Trainer qualification is reported seldomly. Evaluation methods and levels display strong variation.ConclusionsCritical topics were identified for the CRM training community and include the following: the need to agree on common terms and definitions for CRM in healthcare, standards of good practice for reporting CRM interventions and their effects, as well as the need for more research to establish non-educational criteria for success in the implementation of CRM in healthcare organisations.

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AimIn most regions of the world, the proportion of older people in the population has increased during the last decades. As this entails major consequences for the healthcare sector, this study isolates and quantifies the impact of an aging population on the demand for emergency medical services in different types of regions in Bavaria between 2012 and 2032.MethodsDispatch data of the emergency medical services were combined with population data and forecasts. Age-specific rates of emergency ambulance dispatches were calculated and used for a 20-year-projection for all 71 rural and 25 urban districts of Bavaria. Tests for differences between these two types of regions were applied.ResultsPer capita rates of emergency ambulance dispatches in urban regions tend to be higher and there is an urban–rural distinction in the rates of specific age groups. The projection predicted an overall increase in emergency ambulance dispatches by 21 % in Bavaria within 20 years, solely due to demographic effects. At the regional level, this demographic impact ranged from about −3 % to +41 %. There is a clear urban–rural distinction and the 28 regions with the strongest increase are all rural regions.ConclusionThe substantial demographic impact in combination with strong urban–rural variations should be accounted for in regional long-term planning as well as age-group specific innovation in the emergency medical services. As demography is not the only significant demand factor, the identification and quantification of other factors remains a challenge for further research.

Background Pre-hospital emergency medical services (EMS) are an integral part of emergency medical care. EMS planning can be achieved by analyzing patterns of use. However, long-term time trends of EMS use have rarely been studied. The objective of this retrospective study was to investigate utilization patterns over a ten year period, and to compare utilization trends between urban and rural municipalities and between events with and without prehospital emergency physician (PEP) dispatch. Methods Routine data collected by 26 dispatch centers in the federal state of Bavaria, Germany, from 2007 to 2016 was analyzed. Emergency locations were classified into five levels of rurality. Negative binomial mixed effects regression models were fitted to predict emergency rates and to investigate differences in rates and utilization trends. Graphical representation methods were used to compare distribution of transport rates and distribution across daytime and weekday. Results Twelve million two hundred thousand one hundred fifty-five dispatches assigned to 7,725,636 single emergencies were included. The mean number of emergencies per year and 1000 population (emergency rate) was 42.8 (±16.0) in rural municipalities and 80.7 (±9.3) in large cities. Compared to rural municipalities, cities had higher emergency rates without (IRR = 3.0, CI 2.2–4.0) and with pre-hospital physicians (IRR = 1.5, CI 1.2–2.0). Between 2007 and 2016, the absolute number of emergencies increased by 49.1%. Estimated annual percent change of emergency rates without physician activation ranged from 5.7% (CI 4.3–7.1) in cities to 7.8% (CI 7.6–7.9) in rural areas. Changes in emergency rates with physician attendance were lower, with estimated increases between 1.3 and 2.4%. The average proportion of patients transported to a hospital was lower in cities and remained unchanged. There were no considerable differences or changes in the distribution across daytime and weekdays. Conclusion Differences between cities and other areas suggest that the planning of EMS should be targeted to regional characteristics. A substantial increase in emergency rates was observed across all areas of Bavaria, but did not impact transport rates or temporal distributions. Further research is needed to better understand the urgency of emergency events and reasons behind increasing EMS utilization.

Zusammenfassung Hintergrund Die Berichterstattung aus einzelnen Bundesländern zeigt über viele Jahre kontinuierlich steigende Einsatzzahlen im bodengebundenen Rettungsdienst. Fragestellung Ziel der Arbeit ist es aufzuzeigen, wie stark sich die Einsatzzahlen und das Einsatzspektrum im Rettungsdienst in den letzten Jahren entwickelt haben. Material und Methode Die Arbeit führt nach Literaturrecherche geeignete Publikationen synoptisch zusammen, um einen umfassenden Überblick der aktuellen Erkenntnisse zu geben. Ergebnisse Vollerhebungen der Einsatzzahlen einzelner Bundesländer sowie Hochrechnungen der Rettungsdiensteinsätze auf Bundesebene zeigen jährliche Zuwachsraten von etwa 5 %. Zudem belegen einzelne Untersuchungen vor allem einen Anstieg nichttraumatologischer Einsatzgründe. Sowohl die Einsatzzunahme als auch die Änderung im Einsatzspektrum können, neben weiteren Einflussfaktoren, u. a. auf den demografischen Wandel zurückgeführt werden. Schlussfolgerungen Um dem Anstieg und der Änderung der Inanspruchnahme zu begegnen, erscheint neben der Ausweitung bestehender Angebote der Notfallversorgung die Etablierung alternativer Ansätze (z. B. Telenotarzt) zielführend. Begleitend sollte eine umfassende Datenerfassung und -auswertung erfolgen, um im Rahmen des Qualitätsmanagements ein kontinuierliches Nachsteuern des Systems zu erlauben.