Differential Impact of a Crew Resource Management Program According to Professional Specialty

Abstract

Adverse events occur in 3% to 16% of hospital patients, half of these during surgery and related to human error. The authors’ objective was to determine the impact of a crew resource management program in collaboration with Swiss International Airlines. Participants included operating room personnel: surgeons, anesthesiologists, nurses, and technicians. Outcome measures were a 10-item questionnaire evaluating participants’ satisfaction and a 32-item survey to analyze participants’ learning. Nine seminars included 99 participants: 22% surgeons, 19% anesthesiologists, 29% nurses, and 30% nurse’s aides/technicians. Satisfaction was very high for course organization (91%), group dynamics (74%), and teaching methods (68%). Significant improvements in learning were observed after the course in 17 out of 32 questions. Surgeons demonstrated the greatest improvement in knowledge (P = .018), specifically teamwork and safety-related issues. Less improvement was seen for all specialties in stress recognition areas. Crew resource management is valuable in improving operating room staff knowledge regarding teamwork, safety climate, and stress recognition. However, program impact varies with participant specialty.

Keywords

crew resource management differential impact teamwork surgeons specialty

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References

Brennan

Leape

Laird

. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370-376.

Wilson

Runciman

Gibberd

Harrison

Newby

Hamilton

. The Quality in Australian Health Care Study. Med J Aust. 1995;163:458-471.

Baker

Norton

Flintoft

. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170: 1678-1686.

Vincent

Neale

Woloshynowych

. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322:517-519.

Leape

Brennan

Laird

. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377-384.

US General Accounting Office. Human Factors: FAA’s Guidance and Oversight of Pilot Crew Resource Management Training Can Be Improved (Report No. GAO/RCED-98-7). Washington, DC: US General Accounting Office; 1997.

Helmreich

Merritt

Wilhelm

. The evolution of crew resource management training in commercial aviation. Int J Aviat Psychol. 1999;9:19-32.

Cooper

White

Lauber

. Resource Management on the Flightdeck: Proceedings of a NASA/Industry Workshop. Moffet Field, CA: NASA, Ames Research Center; 1980:102.

Wiener

Kanki

Helmreich

. Cockpit Resource Management. San Diego, CA: Academic Press; 1993.

10.

Helmreich

. On error management: lessons from aviation. BMJ. 2000;320:781-785.

11.

Zeltser

Nash

. Approaching the evidence basis for aviation-derived teamwork training in medicine. Am J Med Qual. 2010;25:13-23.

12.

Sax

Browne

Mayewski

. Can aviation-based team training elicit sustainable behavioral change? Arch Surg. 2009;144:1133-1137.

13.

Awad

Fagan

Bellows

. Bridging the communication gap in the operating room with medical team training. Am J Surg. 2005;190:770-774.

14.

Haller

Garnerin

Morales

. Effect of crew resource management training in a multidisciplinary obstetrical setting. Int J Qual Health Care. 2008;20:254-263.

15.

Wolf

Way

Stewart

. The efficacy of medical team training: improved team performance and decreased operating room delays: a detailed analysis of 4863 cases. Ann Surg. 2010;252:477-483.

16.

Neily

Mills

Young-Xu

. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304:1693-1700.

17.

Hall

. Interprofessional teamwork: professional cultures as barriers. J Interprof Care. 2005;19(suppl 1):188-196.

18.

Haynes

Weiser

Berry

. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491-499.

19.

Cohen

. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Earlbaum; 1988.

20.

Carney

Mills

Bagian

Weeks

. Sex differences in operating room care giver perceptions of patient safety: a pilot study from the Veterans Health Administration Medical Team Training Program. Qual Saf Health Care. 2010;19:128-131.

21.

Carney

West

Neily

Mills

Bagian

. Differences in nurse and surgeon perceptions of teamwork: implications for use of a briefing checklist in the OR. AORN J. 2010;91:722-729.

22.

Makary

Sexton

Freischlag

. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg. 2006;202: 746-752.

23.

Sexton

Thomas

Helmreich

. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000;320:745-749.

24.

Thomas

Sexton

Helmreich

. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med. 2003;31:956-959.

25.

Sexton

. The Better the Team, the Safer the World: Golden Rules of Group Interaction in High-Risk Environments. Ladenburg, Germany: Swiss Re Centre for Global Dialog, and the Gottlieb Daimler and Karl Benz Foundation; 2004.

26.

Morey

Simon

Jay

. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res. 2002;37: 1553-1581.