title: A crew resource management program tailored to trauma resuscitation improves team behavior and communication.
abstract: BACKGROUND
  Crew Resource Management (CRM) is a team-building communication process first implemented in the aviation industry to improve safety. It has been used in health care, particularly in surgical and intensive care settings, to improve team dynamics and reduce errors. We adapted a CRM process for implementation in the trauma resuscitation area.
  
  
  METHODS
  An interdisciplinary steering committee developed our CRM process to include a didactic classroom program based on a preimplementation survey of our trauma team members. Implementation with new cultural and process expectations followed. The Human Factors Attitude Survey and Communication and Teamwork Skills assessment tool were used to design, evaluate, and validate our CRM program.
  
  
  RESULTS
  The initial trauma communication survey was completed by 160 team members (49% response). Twenty-five trauma resuscitations were observed and scored using Communication and Teamwork Skills. Areas of concern were identified and 324 staff completed our 3-hour CRM course during a 3-month period. After CRM training, 132 communication surveys and 38 Communication and Teamwork Skills observations were completed. In the post-CRM survey, respondents indicated improvement in accuracy of field to medical command information (p = 0.029); accuracy of emergency department medical command information to the resuscitation area (p = 0.002); and team leader identity, communication of plan, and role assignment (p = 0.001). After CRM training, staff were more likely to speak up when patient safety was a concern (p = 0.002).
  
  
  CONCLUSIONS
  Crew Resource Management in the trauma resuscitation area enhances team dynamics, communication, and, ostensibly, patient safety. Philosophy and culture of CRM should be compulsory components of trauma programs and in resuscitation of injured patients.
authors.affiliation: Trauma Services, York Hospital, York, Pennsylvania. Electronic address: khughes4@wellspan.org.
authors.forename: K Michael
authors.initials: KM
authors.lastname: Hughes
authors.affiliation: Department of Emergency Medicine, York Hospital, York, Pennsylvania.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Benenson
authors.affiliation: Trauma Services, York Hospital, York, Pennsylvania.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krichten
authors.affiliation: Trauma Services, York Hospital, York, Pennsylvania.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Clancy
authors.affiliation: Department of Surgery, York Hospital, York, Pennsylvania.
authors.forename: James Patrick
authors.initials: JP
authors.lastname: Ryan
authors.affiliation: Department of Emergency Medicine, York Hospital, York, Pennsylvania.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hammond
mesh_terms: D019090:Case Management; D003142:Communication; D006801:Humans; D010348:Patient Care Team; D012151:Resuscitation; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000628:therapy*