Savage Carl, Gaffney F Andrew, Hussain-Alkhateeb Laith, Olsson Ackheim Pia, Henricson Gunilla, Antoniadou Irini, Hedsköld Mats, Pukk Härenstam Karin
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Int J Qual Health Care. 2017 Oct 1;29(6):853-860. doi: 10.1093/intqhc/mzx113.
Evaluate longitudinal changes in technical and non-technical skills (teamwork, situation monitoring, communication and leadership), safety culture, and clinical outcomes before and after implementation of a crew resource management (CRM) safety program.
A multi-level prospective single case study in accordance with the SQUIRE-guidelines for reporting quality improvement efforts.
Large university paediatric surgical service.
PARTICIPANT(S): All 153 managers and staff.
Training of staff in CRM, systematic risk assessments, and the redesign of work practices captured and reinforced through the development, implementation and refinement of SOPs.
MAIN OUTCOME MEASURE(S): Data were collected related to: 1) Relevance of CRM training (survey), 2) Safety culture (survey), 3) Team behaviours in clinical practice (non-participatory observations with MedPACT protocol) and 4) Effects on perioperative care for laparoscopic appendectomies-a representative and frequently performed surgical procedure (electronic medical records and administrative data for length of stay, unplanned readmissions and returns to the Operating Room).
Non-technical skills, the use of safety tools, as well as adherence to guidelines for appendectomies all improved significantly over time. Significant safety culture improvements were found in teamwork across and within units, supervisors' expectations and actions, non-punitive response to adverse events, and perceptions of overall patient safety. Unplanned readmissions following appendectomy declined significantly.
Implementation of a comprehensive CRM program including associated safety tools created sustained adherence to new work practices and improved non-technical and technical skills, surgical outcomes and safety culture.
评估实施机组资源管理（CRM）安全计划前后技术和非技术技能（团队合作、情况监测、沟通和领导力）、安全文化及临床结果的纵向变化。
一项根据SQUIRE报告质量改进工作指南进行的多层次前瞻性单案例研究。
大型大学儿科外科服务部门。
所有153名管理人员和工作人员。
对工作人员进行CRM培训、系统风险评估，并通过制定、实施和完善标准操作规程来捕捉和强化工作实践的重新设计。
收集以下方面的数据：1）CRM培训的相关性（调查），2）安全文化（调查），3）临床实践中的团队行为（采用MedPACT方案进行非参与性观察），4）对腹腔镜阑尾切除术围手术期护理的影响——一种具有代表性且经常进行的外科手术（电子病历以及住院时间、非计划再入院和返回手术室情况的行政数据）。
随着时间推移，非技术技能、安全工具的使用以及阑尾切除术指南的遵守情况均有显著改善。在各单位之间和单位内部的团队合作、主管的期望和行动、对不良事件的非惩罚性反应以及对整体患者安全的认知方面，安全文化有显著改善。阑尾切除术后的非计划再入院率显著下降。
实施包括相关安全工具的全面CRM计划可使新工作实践得到持续遵守，并改善非技术和技术技能、手术结果及安全文化。
