title: Crew Resource Management in the Intensive Care Unit: a prospective 3-year cohort study.
abstract: BACKGROUND
  Human factors account for the majority of adverse events in both aviation and medicine. Human factors awareness training entitled "Crew Resource Management (CRM)" is associated with improved aviation safety. We determined whether implementation of CRM impacts outcome in critically ill patients.
  
  
  METHODS
  We performed a prospective 3-year cohort study in a 32-bed ICU, admitting 2500-3000 patients yearly. At the end of the baseline year, all personnel received CRM training, followed by 1 year of implementation. The third year was defined as the clinical effect year. All 7271 patients admitted to the ICU in the study period were included. The primary outcome measure was ICU complication rate. Secondary outcome measures were ICU and hospital length of stay, and standardized mortality ratio.
  
  
  RESULTS
  Occurrence of serious complications was 67.1/1000 patients and 66.4/1000 patients during the baseline and implementation year respectively, decreasing to 50.9/1000 patients in the post-implementation year (P = 0.03). Adjusted odds ratios for occurrence of complications were 0.92 (95% CI 0.71-1.19, P = 0.52) and 0.66 (95% CI 0.51-0.87, P = 0.003) in the implementation and post-implementation year. The incidence of cardiac arrests was 9.2/1000 patients and 8.3/1000 patients during the baseline and implementation year, decreasing to 3.5/1000 patients (P = 0.04) in the post-implementation year, while cardiopulmonary resuscitation success rate increased from 19% to 55% and 67% (P = 0.02). Standardized mortality ratio decreased from 0.72 (95% CI 0.63-0.81) in the baseline year to 0.60 (95% CI 0.53-0.67) in the post-implementation year (P = 0.04).
  
  
  CONCLUSIONS
  Our data indicate an association between CRM implementation and reduction in serious complications and lower mortality in critically ill patients.
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M H T M
authors.initials: MH
authors.lastname: Haerkens
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.|Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kox
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Lemson
authors.affiliation: Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Houterman
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: van der Hoeven
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Pickkers
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies