title: Improving Pediatric Rapid Response Team Performance Through Crew Resource Management Training of Team Leaders.
abstract: Rapid response teams (RRTs) improve the detection of and response to deteriorating patients. Professional hierarchies and the multidisciplinary nature of RRTs hinder team performance. This study assessed whether an intervention involving crew resource management training of team leaders could improve team performance.
  
  
  
  In situ observations of RRT activations were performed pre- and post-training intervention. Team performance and dynamics were measured by observed adherence to an ideal task list and by the Team Emergency Assessment Measure tool, respectively. Multiple quartile (median) and logistic regression models were developed to evaluate change in performance scores or completion of specific tasks.
  
  
  
  Team leader and team introductions (40% to 90%, P = .004; 7% to 45%, P = .03), floor team presentations in Situation Background Assessment Recommendation format (20% to 65%, P = .01), and confirmation of the plan (7% to 70%, P = .002) improved after training in patients transferred to the ICU (n = 35). The Team Emergency Assessment Measure metric was improved in all 4 categories: leadership (2.5 to 3.5, P < .001), teamwork (2.7 to 3.7, P < .001), task management (2.9 to 3.8, P < .001), and global scores (6.0 to 9.0, P < .001) for teams caring for patients who required transfer to the ICU.
  
  
  
  Targeted crew resource management training of the team leader resulted in improved team performance and dynamics for patients requiring transfer to the ICU. The intervention demonstrated that training the team leader improved behavior in RRT members who were not trained.
authors.affiliation: Children's National Health System, Washington, DC asiems@cnmc.org.
authors.forename: Ashley
authors.initials: A
authors.lastname: Siems
authors.affiliation: Children's National Health System, Washington, DC.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cartron
authors.affiliation: Children's National Health System, Washington, DC.
authors.forename: Anne
authors.initials: A
authors.lastname: Watson
authors.affiliation: Children's National Health System, Washington, DC.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.affiliation: Children's National Health System, Washington, DC.
authors.forename: Amanda
authors.initials: A
authors.lastname: Levin
mesh_terms: D002648:Child; D002675:Child, Preschool; D000067498:Crew Resource Management, Healthcare / Q000379:methods / Q000592:standards; D003422:Critical Care / Q000379:methods / Q000592:standards; D004219:District of Columbia; D004493:Education; D005260:Female; D057209:Hospital Rapid Response Team / Q000592:standards*; D006801:Humans; D007223:Infant; D007857:Leadership; D008297:Male; D058996:Quality Improvement; D012151:Resuscitation / Q000193:education*; D013647:Task Performance and Analysis; D000066477:Work Performance / Q000193:education / Q000592:standards