title: Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial.
abstract: BACKGROUND
  Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and organizational outcomes, due to weak study designs and the scarce use of direct observations. Therefore, the aim of this study is to determine the effectiveness and cost-effectiveness of CRM training on attitude, behaviour and organization after one year, using a multi-method approach and matched control units. The purpose of the present article is to describe the study protocol and the underlying choices of this evaluation study of CRM in the ICU in detail.
  
  
  METHODS
  Six ICUs participated in a paired controlled trial, with one pre-test and two post test measurements (respectively three months and one year after the training). Three ICUs were trained and compared to matched control ICUs. The 2-day classroom-based training was delivered to multidisciplinary groups. Typical CRM topics on the individual, team and organizational level were discussed, such as situational awareness, leadership and communication. All levels of Kirkpatrick's evaluation framework (reaction, learning, behaviour and organisation) were assessed using questionnaires, direct observations, interviews and routine ICU administration data.
  
  
  CONCLUSIONS
  It is expected that the CRM training acts as a generic intervention that stimulates specific interventions. Besides effectiveness and cost-effectiveness, the assessment of the barriers and facilitators will provide insight in the implementation process of CRM.
  
  
  BACKGROUND
  Netherlands Trial Register (NTR): NTR1976.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. p.kemper@vumc.nl
authors.forename: Peter F
authors.initials: PF
authors.lastname: Kemper
authors.forename: Martine
authors.initials: M
authors.lastname: de Bruijne
authors.forename: Cathy
authors.initials: C
authors.lastname: van Dyck
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D005500:Follow-Up Studies; D006801:Humans; D007318:Inservice Training / Q000191:economics / Q000379:methods*; D007362:Intensive Care Units / Q000458:organization & administration*; D009426:Netherlands; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D010559:Personnel Management / Q000379:methods*; D012107:Research Design
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