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

Abstract

IntroductionErrors 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 studyTo assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team.Material and MethodsSeventy 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.ResultsAn improvement was seen in most of the measured clinical parameters.ConclusionOur 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.

Novice Doctors in the Emergency Department: A Scoping Review

“…The efficacy of simulation may further be improved by creating the most realistic working environment possible [ 14 ]. Courses on teamwork and crisis resource management [ 38 ] are effective in improving team performance [ 7 , 17 , 39 ]. In addition, they reduce the stress levels of novice doctors [ 40 ].…”

Emergency crisis resource management: a simulation-based course developed by the Spanish Society of Emergency Medicine (SEMES) for health sciences students

“…Los servicios de urgencias y emergencias son entornos complejos de atención al paciente crítico, donde el trabajo en equipo es imprescindible para alcanzar una atención asistencial de alta calidad 1 . Sin embargo, las constantes interrupciones y distracciones durante el proceso asistencial, las ambigüedades de diagnóstico y el estrés alteran el rendimiento de los profesionales, y originan eventos adversos 2 . Los eventos adversos se definen como los resultados negativos y perjudiciales que se producen cuando un paciente ha recibido atención médica 3 .…”