TY - JOUR
T1 - Lessons in Flying
T2 - Crew resource management as a quality improvement method for acute coronary syndromes care
AU - Levy, Phillip D.
AU - Dancy, Janeen N.
AU - Stowell, Stephanie A.
AU - Hoekstra, James W.
AU - Arthur, Crystal L.
AU - Wilson, Charles H.
AU - Bednar, John M.
AU - Dorman, Todd
AU - Hiestand, Brian
PY - 2014/3/1
Y1 - 2014/3/1
N2 - Providing timely, high-quality, guideline-based care to patients with acute coronary syndromes (ACS) who present to the emergency department is critically dependent on cooperation, coordination, and communication between emergency medicine physicians and cardiologists. However, to achieve sustained improvement at the individual institution level, consistent implementation of quality improvement (QI) activities is needed. We describe a QI initiative for ACS care in the emergency setting that combined clinical education with a curriculum based on crew resource management (CRM) principles - a set of tools and techniques for communication, teamwork, and error avoidance used in the aviation industry and with proven applicability in the healthcare setting. Educational training sessions were open to multidisciplinary healthcare teams at 3 hospital sites, and participants were provided practical tools and resources to enhance communication, teamwork, and patient-centered care. Through patient chart reviews, participant surveys, and clinician interviews, baseline assessments of clinical performance measures and team communication-, logistics-, and skills-based efficiencies were performed and reported before the educational training was delivered at each QI site. Reviews of pre- and postinitiative participant surveys demonstrated improvement in knowledge and confidence in the delivery of appropriate and effective ACS care; however, reviews of pre- and postinitiative patient charts revealed limited process improvements. Altogether, this multicenter study of a continuing medical education program based on CRM principles was associated with improvements in provider knowledge and confidence regarding the delivery of appropriate ACS care, but had limited impact on clinical performance measures.
AB - Providing timely, high-quality, guideline-based care to patients with acute coronary syndromes (ACS) who present to the emergency department is critically dependent on cooperation, coordination, and communication between emergency medicine physicians and cardiologists. However, to achieve sustained improvement at the individual institution level, consistent implementation of quality improvement (QI) activities is needed. We describe a QI initiative for ACS care in the emergency setting that combined clinical education with a curriculum based on crew resource management (CRM) principles - a set of tools and techniques for communication, teamwork, and error avoidance used in the aviation industry and with proven applicability in the healthcare setting. Educational training sessions were open to multidisciplinary healthcare teams at 3 hospital sites, and participants were provided practical tools and resources to enhance communication, teamwork, and patient-centered care. Through patient chart reviews, participant surveys, and clinician interviews, baseline assessments of clinical performance measures and team communication-, logistics-, and skills-based efficiencies were performed and reported before the educational training was delivered at each QI site. Reviews of pre- and postinitiative participant surveys demonstrated improvement in knowledge and confidence in the delivery of appropriate and effective ACS care; however, reviews of pre- and postinitiative patient charts revealed limited process improvements. Altogether, this multicenter study of a continuing medical education program based on CRM principles was associated with improvements in provider knowledge and confidence regarding the delivery of appropriate ACS care, but had limited impact on clinical performance measures.
KW - Acute coronary syndromes
KW - Emergency medicine
KW - Quality improvement
UR - http://www.scopus.com/inward/record.url?scp=84894500303&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84894500303&partnerID=8YFLogxK
U2 - 10.1097/HPC.0000000000000002
DO - 10.1097/HPC.0000000000000002
M3 - Article
C2 - 24526150
AN - SCOPUS:84894500303
SN - 1535-282X
VL - 13
SP - 36
EP - 42
JO - Critical Pathways in Cardiology
JF - Critical Pathways in Cardiology
IS - 1
ER -