Cctc

EUROANESTHESIA 2005
Vienna, Austria 28-31 May 2005

CRISIS RESOURCE MANAGEMENT TO IMPROVE PATIENT SAFETY
MARCUS RALL (1) (1) Center for Patient Safety and Simulation Dep. of Anesthesiology and Intensive Care Medicine University Hospital Tuebingen Tuebingen, Germany Saturday May 28, 2005 14:00-14:45

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PETER DIECKMANN (1,2) (2) Institute of Work Psychology Swiss Federal Institute ofTechnology (ETH) Zurich, Switzerland Room R

General principles of managing critical situations and preventing errors in anesthesia and intensive care medicine

ERRORS IN MEDICINE, PATIENT SAFETY AND HUMAN FACTORS
“Safety is a dynamic non-event” [1] Safety Culture is “A collection of characteristics and attitudes in an organization, promoted by its leaders and internalized by its members, thatmakes safety an overriding priority” [2] Patient safety in developed countries is good, but not good enough. According to the IOM-Report “To err is human”, between 44,000 and 98,000 people die from medical errors each year in the US [3]. Many more are damaged by medical errors. These numbers are similar for other countries. Many of these outcomes are not due to inadequate medical knowledge but toproblems in transforming that knowledge into meaningful clinical actions under the real world conditions of patient care [4]. In complex working systems like anesthesia decisions have to be made under conditions of uncertainty and time pressure. Working in multiprofessional teams requires coordination and communication skills which are not taught in medical school. Up to 70% of all errors can beattributed to human factors. It is time for medicine to acknowledge this and to adopt strategies to prevent those human errors harming patients. One way of reducing human factor errors is the CRM (Crisis Resource Management) concept.

WHAT IS CRM?
Crisis Resource Management (CRM) was introduced in aviation and has proved successful in many other industries. Gaba and colleagues transferred andadapted CRM to medicine and called it Anesthesia Crisis Resource Management [4]. CRM aims to coordinate, utilise and apply all available resources to optimise patient safety and outcomes. Resources include all people involved with all their skills, abilities and attitudes – as well as their limitations, in addition to equipment. CRM begins before the crisis. All the principles that help in dealingwith an acute crisis also help avoid the crisis in the first place. CRM is about capturing errors as soon as possible and minimizing the negative consequences of errors which have already occurred. Gaba, Howard and Fish developed key points of CRM for anesthesia and these were recently updated [5]. TABLE 1: CRM KEY POINTS5 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Know the environmentAnticipate and plan Call for help early Exercise leadership and followership Distribute the workload Mobilize all available resources Communicate effectively Use all available information Prevent and manage fixation errors Cross (double) check Use cognitive aids Re-evaluate repeatedly Use good teamwork Allocate attention wisely Set priorities dynamically

(from Rall M, Gaba DM: Human Performanceand Patient Safety, in Miller 6th edition 2005)

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HOW TO APPLY KEY POINTS OF CRM
CRM key points are designed to focus your attention on factors which might improve patient safety. As you read through these principles you may think them trivial. Our experience with simulator training shows that applying these principles during routine work and especially during crises makes differenceswhich are far from trivial. For each of these principles, think them through and ask yourself for each key point: • • • • • • • How does it apply to your job and work environment (colleagues and organisation)? Which problems have you experienced in your work related to the key points? Which problems have you observed in other people’s work? How could you improve that using the key point? How did you...