Are simulation and didactic crisis resource management (CRM) training synergistic?

Operating Room Crisis Checklists and Emergency Manuals

Crisis checklists and emergency manuals are cognitive aids that help team performance and adherence to evidence-based practices during operating room crises. Resources to enable local implementation and training (key for effective use) are linked at http://www.emergencymanuals.org.

Supplemental Digital Content is available in the text.

Do you want to play? Factors influencing nurse academics' adoption of simulation in their teaching practices

Simulation based education (SBE) in healthcare is gaining popularity. It provides an opportunity for students to acquire and practice clinical skills in a safe and controlled environment and is also a potential solution to alleviating the increasing pressure on clinical placement availability. While there is growing evidence of the value of simulation to learners there is little understanding of the factors that influence academics attitudes towards and choices about the use simulation. Through an exploratory research design using semi-structured interviews, nurse academics' opinions, experiences and attitudes regarding simulation were captured. Thematic analysis was conducted utilising a cross comparative approach. Three themes Simulation as a Separate Entity; Getting Political, and Academic Adaptation were identified. These themes were then explored through the five essential characteristics of innovation identified in the persuasion phase of Roger's Diffusion of Innovation Model (1995). The findings indicated that in order to successfully integrate simulation into a university curriculum, the factors influencing nurse academics' attitudes and choices around simulation must be understood and addressed to avoid fragmentation of teaching and learning and to support strong learning outcomes.

Simulation-based trial of surgical-crisis checklists

BACKGROUND

Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians. Successful management is difficult and complex. We sought to evaluate a tool to improve adherence to evidence-based best practices during such events.

METHODS

Operating-room teams from three institutions (one academic medical center and two community hospitals) participated in a series of surgical-crisis scenarios in a simulated operating room. Each team was randomly assigned to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone. The primary outcome measure was failure to adhere to critical processes of care. Participants were also surveyed regarding their perceptions of the usefulness and clinical relevance of the checklists.

RESULTS

A total of 17 operating-room teams participated in 106 simulated surgical-crisis scenarios. Failure to adhere to lifesaving processes of care was less common during simulations when checklists were available (6% of steps missed when checklists were available vs. 23% when they were unavailable, P<0.001). The results were similar in a multivariate model that accounted for clustering within teams, with adjustment for institution, scenario, and learning and fatigue effects (adjusted relative risk, 0.28; 95% confidence interval, 0.18 to 0.42; P<0.001). Every team performed better when the crisis checklists were available than when they were not. A total of 97% of the participants reported that if one of these crises occurred while they were undergoing an operation, they would want the checklist used.

CONCLUSIONS

In a high-fidelity simulation study, checklist use was associated with significant improvement in the management of operating-room crises. These findings suggest that checklists for use during operating-room crises have the potential to improve surgical care. (Funded by the Agency for Healthcare Research and Quality.).

Simulation: translation to improved team performance

Traditional medical education has emphasized autonomy, and until recently issues related to teamwork have not been explicitly included in medical curriculum. The Institute of Medicine highlighted that health care providers train as individuals, yet function as teams, creating a gap between training and reality and called for the use of medical simulation to improve teamwork. The aviation industry created a program called Cockpit and later Crew Resource Management that has served as a model for team training programs in medicine. This article reviews important concepts related to teamwork and discusses examples where simulation either could be or has been used to improve teamwork in medical disciplines to enhance patient safety.

Crew resource management and team training

This article reviews medical team training using the principles of crew resource management (CRM). It also briefly discusses crisis resource management, a subset of CRM, as applied to high-acuity medical situations. Guidelines on setting up medical team training programs are presented. Team training programs are classified and examples of simulation-based and classroom-based programs are offered and their merits discussed. Finally, a brief look at the future of team training concludes this review article.