Crisis Resources for Emergency Workers (CREW II): Results of a pilot study and simulation-based crisis resource management course for emergency medicine residents

Abstract

Objectives: Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviation based crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of "Crisis Resources for Emergency Workers" (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents. Methods: Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and post course simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS). Results: Post course survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a no nsignificant trend toward improved team based attitudes as assessed by the HFAS (p = 0.210). Post course performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p = 0.16). Conclusions: EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size. © Canadian Association of Emergency Physicians.