Carl Savage1, F Andrew Gaffney1,2, Laith Hussain-Alkhateeb3, Pia Olsson Ackheim4, Gunilla Henricson4, Irini Antoniadou4, Mats Hedsköld1, Karin Pukk Härenstam1,4. 1. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-171 77 Stockholm, Sweden. 2. Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, TN 37232, USA. 3. Health Metrics, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden. 4. Division of Paediatrics, Karolinska University Hospital, Astrid Lindgren's Childrens' Hospital, SE-171 76 Stockholm, Sweden.
Abstract
OBJECTIVE: 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. DESIGN: A multi-level prospective single case study in accordance with the SQUIRE-guidelines for reporting quality improvement efforts. SETTING: Large university paediatric surgical service. PARTICIPANT(S): All 153 managers and staff. INTERVENTIONS: 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). RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: 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. DESIGN: A multi-level prospective single case study in accordance with the SQUIRE-guidelines for reporting quality improvement efforts. SETTING: Large university paediatric surgical service. PARTICIPANT(S): All 153 managers and staff. INTERVENTIONS: 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). RESULTS: 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. CONCLUSIONS: 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.
Authors: Benedict Gross; Leonie Rusin; Jan Kiesewetter; Jan M Zottmann; Martin R Fischer; Stephan Prückner; Alexandra Zech Journal: BMJ Open Date: 2019-03-01 Impact factor: 2.692
Authors: Mats Hedsköld; Magna Andreen Sachs; Torleif Rosander; Mia von Knorring; Karin Pukk Härenstam Journal: BMC Health Serv Res Date: 2021-01-08 Impact factor: 2.655
Authors: Vincenzo Restivo; Giuseppa Minutolo; Alberto Battaglini; Alberto Carli; Michele Capraro; Maddalena Gaeta; Anna Odone; Cecilia Trucchi; Carlo Favaretti; Francesco Vitale; Alessandra Casuccio Journal: Int J Environ Res Public Health Date: 2022-09-02 Impact factor: 4.614