Crisis resource management: Evaluating outcomes of a multidisciplinary team
ABSTRACT Crisis resource management (CRM) is a team-training program that teaches nontechnical skills such as: collaboration, communication, task management, teamwork, and leadership. The purpose of this study was to evaluate improvement in the nontechnical skills of a multidisciplinary team of pediatric residents, anesthesiology residents and pediatric nurses following participation in the CRM educational program. Self-efficacy theory guided the teaching method used in the CRM program. The Collaboration and Satisfaction about Care Decisions instrument and the Anesthetists' Nontechnical Skills System served as outcome measures. Seven multidisciplinary groups were studied with a total of 40 subjects. A significant increase was found in posttest scores for perceived collaboration and satisfaction with care and in numerical ratings of observed team skills following the CRM program. The results suggest multidisciplinary team participation in the CRM program increased perceived team collaboration, satisfaction with care, and observed teamwork skills.
- SourceAvailable from: Lia FluitTijdschrift voor Medisch Onderwijs 03/2012; DOI:10.1007/s12507-011-0016-x
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ABSTRACT: Objective: Human factors and teamwork are major contributors to sentinel events. A major limitation to improving human factors and teamwork is the paucity of objective validated measurement tools. Our goal was to develop a brief tool that could be used to objectively evaluate teamwork in the field during short clinical team simulations and in everyday clinical care. Study Design: A pilot validation study. Standardized videos were created demonstrating poor, average, and excellent teamwork among an obstetric team in a common clinical scenario (shoulder dystocia). Three evaluators all trained in Crew Resource Management, and unaware of assigned teamwork level, independently reviewed videos and evaluated teamwork using the Clinical Teamwork Scale (CTS). Statistical analysis included calculation of the Kappa statistic and Kendall coefficient to evaluate agreement and score concordance among raters, and Interclass Correlation Coefficient (ICC) to evaluate interrater reliability. The reliability of the tool was further evaluated by estimating the variance of each component of the tool based on generalizability theory. Results: There was substantial agreement (Kappa 0.78) and score concordance (Kendall coefficient 0.95) among raters, and excellent interrater reliability (interclass correlation coefficient 0.98). The highest percentage of variance in scores among raters was because of rater/item interaction. Conclusion: The CTS was developed to efficiently measure key clinical teamwork skills during simulation exercises and in everyday clinical care. It contains 15 questions in 5 clinical teamwork domains (communication, situational awareness, decision-making, role responsibility, and patient friendliness). It is easy to use and has construct validity with median ratings consistently corresponding with the intended teamwork level. The CTS is a brief, straightforward, valid, reliable, and easy-to-use tool to measure key factors in teamwork in simulated and clinical settings.Simulation in healthcare: journal of the Society for Simulation in Healthcare 12/2007; 3(4):217-223. DOI:10.1097/SIH.0b013e31816fdd0a · 1.59 Impact Factor
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ABSTRACT: Obstetric crises are unexpected and random. Traditionally, medical training for these acute events has included lectures combined with arbitrary clinical experiences. This educational paradigm has inherent limitations. During actual crises insufficient time exists for discussion and analysis of patient care. Our objective was to create a simulation program to fill this experiential gap. Ten L&D teams participated in high fidelity simulation training. A team consisted of two or three nurses, one anesthesia resident and one or two obstetric residents. Each team participated in two scenarios; epidural-induced hypotension followed by an amniotic fluid embolism. Each simulation was followed by a facilitated debriefing. All simulations were videotaped. Clinical performances of the obstetric residents were graded by two reviewers using the videotapes and a faculty-developed checklist. Recurrent errors were analyzed and graded using Health Failure Modes Effects Analysis. All team members completed a course evaluation. Performance deficiencies of the obstetric residents were identified by an expert team of reviewers. From this list of errors, the "most valuable lessons" requiring further focused teaching were identified and included 1) Poor communication with the pediatric team, 2) Not assuming a leadership role during the code, 3) Poor distribution of workload, and 4) Lack of proper use of low/outlet forceps. Participants reported the simulation course allowed them to learn new skills needed by teams during a crisis. Simulated obstetric crises training offers the opportunity for educators to identify specific performance deficits of their residents and the subsequent development of teaching modules to address these weaknesses.Simulation in healthcare: journal of the Society for Simulation in Healthcare 09/2008; 3(3):154-60. DOI:10.1097/SIH.0b013e31818187d9 · 1.59 Impact Factor