Verbeek-van Noord Inge, de Bruijne Martine C, Twisk Jos W R, van Dyck Cathy, Wagner Cordula
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
J Eval Clin Pract. 2015 Feb;21(1):137-44. doi: 10.1111/jep.12261. Epub 2014 Oct 15.
RATIONALE, AIMS AND OBJECTIVES: Aviation-based crew resource management trainings to optimize non-technical skills among professionals are often suggested for health care as a way to increase patient safety. Our aim was to evaluate the effect of a 2-day classroom-based crew resource management (CRM) training at emergency departments (EDs) on explicit professional oral communication (EPOC; non-technical skills).
A pragmatic controlled before-after trial was conducted. Four EDs of general teaching hospitals were recruited (two intervention and two control departments). ED nurses and ED doctors were observed on their non-technical skills by means of a validated observation tool (EPOC). Our main outcome measure was the amount of EPOC observed per interaction in 30 minutes direct observations. Three outcome measures from EPOC were analysed: human interaction, anticipation on environment and an overall EPOC score. Linear and logistic mixed model analyses were performed. Models were corrected for the outcome measurement at baseline, days between training and observation, patient safety culture and error management culture at baseline.
A statistically significant increase after the training was found on human interaction (β=0.27, 95% CI 0.08-0.49) and the overall EPOC score (β=0.25, 95% CI 0.06-0.43), but not for anticipation on environment (OR=1.19, 95% CI .45-3.15). This means that approximately 25% more explicit communication was shown after CRM training.
We found an increase in the use of CRM skills after classroom-based crew resource management training. This study adds to the body of evidence that CRM trainings have the potential to increase patient safety by reducing communication flaws, which play an important role in health care-related adverse events.
原理、目的和目标：基于航空领域的机组资源管理培训旨在优化专业人员的非技术技能，常被建议应用于医疗保健领域，作为提高患者安全的一种方式。我们的目的是评估在急诊科进行为期两天的基于课堂的机组资源管理（CRM）培训对明确的专业口头沟通（EPOC；非技术技能）的影响。
进行了一项实用的前后对照试验。招募了四家综合教学医院的急诊科（两个干预科室和两个对照科室）。通过一种经过验证的观察工具（EPOC）对急诊科护士和医生的非技术技能进行观察。我们的主要结局指标是在30分钟的直接观察中每次互动观察到的EPOC量。分析了EPOC的三个结局指标：人际互动、对环境的预判和EPOC总分。进行了线性和逻辑混合模型分析。模型针对基线时的结局测量、培训与观察之间的天数、基线时的患者安全文化和差错管理文化进行了校正。
培训后在人际互动（β=0.27，95%可信区间0.08 - 0.49）和EPOC总分（β=0.25，95%可信区间0.06 - 0.43）方面发现有统计学意义的增加，但在对环境的预判方面没有（比值比=1.19，95%可信区间0.45 - 3.15）。这意味着CRM培训后明确沟通增加了约25%。
我们发现基于课堂的机组资源管理培训后CRM技能的使用有所增加。这项研究补充了证据，表明CRM培训有可能通过减少在医疗保健相关不良事件中起重要作用的沟通缺陷来提高患者安全。
