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Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents

Published online by Cambridge University Press:  11 May 2015

Christopher M. Hicks ,
Alex Kiss ,
Glen W. Bandiera  and
Christopher J. Denny
Christopher M. Hicks*
Affiliation:
Division of Emergency Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON
Alex Kiss
Affiliation:
Institute for Clinical and Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON
Glen W. Bandiera
Affiliation:
Division of Emergency Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON
Christopher J. Denny
Affiliation:
Division of Emergency Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON
*
Division of Emergency Medicine, University of Toronto, St. Michael's Hospital, 1-008e Shuter Wing, 30 Bond Street, Toronto, ON M5B 1W8; christopher.hicks@utoronto.ca.

Abstract

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Objectives:

Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviationbased crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of “Crisis Resources for Emergency Workers” (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents.

Methods:

Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS).

Results:

Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved teambased attitudes as assessed by the HFAS (p = 0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p = 0.16).

Conclusions:

EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

Keywords

crisis resource managementmedical educationpatient safety
Type
Education • Enseignement
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 6 , November 2012 , pp. 354 - 362
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

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