Improving nontechnical skills of an interprofessional emergency medical team through a one day crisis resource management training

Abstract

Errors are frequent in healthcare, but Emergency Departments are among the highest risk areas due to frequent changes in team composition, complexity and variety of cases, and difficulties encountered in managing multiple patients simultaneously.Crisis resource management (CRM) training has been associated with decreased error rates in the aviation industry as well as in certain areas of acute medical care, such as anesthesia and emergency medicine. In this study, we assessed whether a single day CRM training, combining didactic and simulation sessions, improves nontechnical skills (NTS) of interprofessional emergency medical teams.Seventy 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 2 in situ simulated exercises. The exercises were videotaped and were evaluated by 2 assessors who were blinded as to whether it was the initial or the final exercise. They used a new tool designed specifically for the assessment of emergency physicians’ NTS. The intervention consisted of one-day training, combining didactic and simulation sessions, followed by an instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.A significant improvement (P < 0.05) was shown for all the NTS assessed, in all professional categories involved, regardless of the duration of prior work experience in the Emergency Department.This study shows that even a short intervention, such as a single day CRM training, can have a significant impact in improving NTS, and can potentially improve patient safety.

Non-technical skills: a review of training and evaluation in urology

“…Yee et al [24] also evaluated one similar CRM intervention and showed improvement at 1 and 2 months in all NTS categories. However, other studies do not show this retention [23]. CRM training is incorporated into a wider urology curriculum by Khan et al [21], which shows feasibility and acceptability.…”

“…CRM training, which addresses NTS in emergency scenarios, has been used successfully in aviation and acute care and is associated with a reduction in errors. Truta et al [23] created a single-day CRM course with both didactic and simulation training for interprofessional EM teams. It resulted in significant NTS improvement two months following the course in all aspects of NTS for all levels of training.…”

“…Studies which do follow up participants show NTS retention for at least 2 months in current training programmes, in which some claiming trainees are still benefitting at 6 months, but others note that there is no significant difference between the NoTSS scores of surgeons who have previously undertaken NTS training versus those who have not. These studies often employ a second simulation session to record improvement and do not look at real performance in the OR [23,26,35]. The longer-term effects of any courses are yet to be shown, but repeat training is necessary to maintain skills after they are learnt initially and make sure they translate to practice [35].…”

“…The longer-term effects of any courses are yet to be shown, but repeat training is necessary to maintain skills after they are learnt initially and make sure they translate to practice [35]. This poses two unanswered questions: how frequent should NTS training be and how should 'refresher' courses be structured [23,26]?…”

“…Participants found this to be a safe and positive educational experience [30]. In another study, CRM scenarios were followed by an instructor facilitated debriefing, with both teams involved in each other's debriefing [23]. Both group and individual methods are able to adequately facilitate learning; thus, the method used should be decided based on logistical considerations and preference of the examiner.…”