crew resource management - itls · gross b, rusin l, kiesewetter j, et al crew resource management...
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Crew Resource ManagementDr. James French @grade1view jms.french@gmail.com
Faculty/Presenter Disclosure
Faculty: Dr James French @grade1view jms.french@gmail.com
Grants/Research Support: New Brunswick Trauma Program 10K CAD Sim IRAP 1.6 M CAD AI ACOA 1.0 M CAD AI
Speakers Bureau/Honoraria: Nil
Applied R&D: Canadian Healthcare Solutions
Patents: Nil
Other: Medical Director “A Teams!“
1. Communications failures2. Diagnostic Error3. Teamwork breakdown. 4. Human Error. 5. Systems failures.
https://psnet.ahrq.gov/resources/resource/1524/Error-in-medicine
Why are airlines safe?
CRM
CRM
1. What is going on? Situational awareness
Think Fast + Think Slow
PATIENTCABCDE VITALS SAMPLE hx POCUS PXR/CXR
SYNTHESISType 2 Pause - Am I Biased? Information missing? Put it together.
UPDATEShare a summary to make a team mental model.
Situational Awareness
2. Free your mind
Miller’s Law
Cognitive Offloading - Use a checklist!
3. Communication
Chunks Checklists
Commentary Working Closed Loop Summaries
Miller’s Law
Communicate in Chunks
Close Loop Communication
Commentary Working
Use Summaries
What is the case? What have we found? What have we done? What do we do next?
4. Role Definition
Graded Assertivness
5. Resilience
Yerkes - Dodson Law
Tactical Breathing
Positive Self Talk
Mental Rehearsal
Win the play then the game
5. Leadership
Leadership = Culture
5. Leadership = CRM
P
E
S
T
P
U
Update - Share Mental Model as Summary
S
SELFWhat is the case? What is my Role? Visualize Tasks +ve Talk Box Breathing
TEAMAlert Hospital? Team Identified? Roles assigned? Mini Teams? Call in others? Alert others?
ENVIRONMENT SYSTEMSTVR? MTP? Airway Kit Dump? Pre draw meds? Trauma Tower + Cart?
PATIENTCABCDE VITALS SAMPLE hx POCUS PXR/CXR
SYNTHESISType 2 Pause - Am I Biased? Information missing? Put it together.
UPDATEShare a summary to make a team mental model.
PATIENT PRIORITIESCompress Bleeding? Rule of 2s? Splints? MTP? RSI? Thoracostomies?
Pre arrivalArrival
6. Make
Beautiful Music
Sheet music Practice the whole song Rehearsal
Skills
Mastery Learning
Microskills RCDP Simulation
Medium skill station short scenario full scenario
Tempo Slow Realtime Realtime
Feedback Step Coaching End coaching Non Judgemental
Performance Elements
Psychomotor, Equipment,
Communication.
Psychomotor Equipment,
System, Communication,
Resilience.
All
Gross B, Rusin L, Kiesewetter J, et al Crew resource management training in healthcare: a systematic review of intervention design, training conditions and evaluation BMJ Open 2019;9:e025247.
Credit and thanks to……
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