Crisis Resource Management (CRM)

• Concepts starting in aviation as Crew Resource Management

• Majority of plane crashes caused by communication errors.

• Blend of technical and non-technical skills that improved cockpit performance and enhanced safety.

• Adapted by Dr. Gaba for use with anesthesiologists.

CRM Principles

• Know the environment• Anticipate and plan• Call for help early• Exercise leadership and

followership• Distribute the workload• Mobilize and use all

resources• Communicate effectively

• Monitor, cross-check and use available data

• Prevent and manage fixation errors

• Re-evaluate and use cognitive aids

• Effective teamwork• Allocate attention wisely• Set priorities dynamically

Rall M, Gaba, D. Miller Anesthesia, 6th Ed.

TeamSTEPPS tools

• Team Events– Briefs – planning– Huddles – problem

solving– Debriefs – process

improvement

• Situation monitoring– Shared mental model– D – describe situation– E – express concerns– S – suggest alternatives– C – consequences

– C- I am concerned– U –I am uncomfortable– S- This is a safety issue

Team Performance Observation Tool

• Used to rate team performance on simulation scenarios

• Can guide debriefing discussion

Using Simulation in

TeamSTEPPS® Training

http://www.ahrq.gov/teamsteppstools/simulation/index.html

Observable Behaviors•Brief team on situation and goals •Encourage the sharing of information •Use commonly understood terminology •Direct communication to specific person(s) •Confirm communication (closed loop) •Ask for clarification •State directions and information clearly •Explain medical information using commonly understood language •Health professional confirms communication from patient •Update patient on changing conditions •Verbalize problems •Announce plans, seek confirmation or consultation •Introduce self/other HC workers, explain role

IndividualRating Tools

Team WorkRating Tools

Evaluation of Teams• Characteristics of Effective Teams• Team Leadership• Backup Behavior• Mutual Performance Monitoring• Communication• Shared Mental Model• Mutual Trust

by Guise et al

Best Practices1. Grounded in theory2. Design to meet

specific learning outcomes

3. Capture relevant competencies

4. Measure multiple levels of performance

5. Link to the training event

6. Observable behaviors

7. Multi-source measurement

8. Capture performance processes

9. Create diagnostic power

10.Train observers11.Facilitate Debriefing

Rosen, M.A. et al, Sim Healthcare 3:33-41, 2008

Hunt, EA