Crew Resource Management in the trauma room: a prospective 3-year cohort study.
OBJECTIVE
Human factors account for the majority of adverse events. Human factors awareness training entitled Crew Resource Management (CRM) is associated with improved safety and reduced complications and mortality in critically ill patients. We determined the effects of CRM implementation in the trauma room of an Emergency Department (ED).


METHODS
A prospective 3-year cohort study was carried out in a level 1 ED, admitting more than 12 000 patients annually (>1500 trauma related). At the end of the baseline year, CRM training was performed, followed by an implementation year. The third year was defined as the clinical effect year. The primary outcomes were safety climate, measured using the Safety Attitudes Questionnaire, and ED length of stay. The secondary outcome measures were hospital length of stay and 48-h crude mortality of trauma patients.


RESULTS
All 5070 trauma patients admitted to the ED during the study period were included. Following CRM implementation, safety climate improved significantly in three out of six Safety Attitudes Questionnaire domains, both at the end of the implementation and clinical effect years: teamwork climate, safety climate, and stress recognition. ED length of stay of these patients increased from 141 (102-192) in the baseline year to 161 (116-211) and 170 (128-223) min in the implementation and clinical effect years, respectively (P<0.05 vs. baseline). Hospital length of stay was prolonged by 1 day in the implementation and clinical effect years (P<0.05 vs. baseline), whereas mortality was unaltered.


CONCLUSIONS
Although CRM implementation in the ED was associated with an improved safety climate, the time spent by trauma patients in the ED increased.
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen.|Wings of Care, Vught.
Marck H T M
MHTM
Haerkens
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen.
Matthijs
M
Kox
Department of Emergency Medicine, Isala Hospital, Zwolle, The Netherlands.
Pieter M
PM
Noe
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen.
Johannes G
JG
Van Der Hoeven
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen.
Peter
P
Pickkers
D019090:Case Management / Q000458:organization & administration*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D017751:Safety Management