A training program modeled on airline industry initiatives can change behavior and cultivate a culture of safety in the operating room, based on data from a survey and follow-up study.
Such training increased acceptance of perioperative checklists, led to more self-reporting of “unsafe conditions and near misses,” and enhanced empowerment in two medical facilities.
“The introduction of CRM [crew resource management] training, combined with other initiatives, enhances personal commitment to patient safety and appears to alter behaviors relative to checklist use and self-reporting,” reported Dr. Harry C. Sax of the department of surgery at Brown University and the Miriam Hospital, both in Providence, R.I., and his colleagues (Arch. Surg. 2009;144:1133–7).
They reported the results of a CRM program begun at the University of Rochester (N.Y.) Strong Medical Center in 2003, and at Brown University's Miriam Hospital in 2005. Of the 858 participants, half were nurses, 28% ancillary personnel, and 22% physicians.
A 10-item perioperative checklist “modeled on preflight aviation checklists,” was posted in each operating room. It listed all participants and required signoffs from two team members regarding items such as surgical site and side verifications, use of perioperative antibiotics, deep vein thrombosis prophylaxis, and beta-blockade, Dr. Sax and his colleagues wrote. A survey that measured attitudes toward safety was given immediately before and after training, and again at least 2 months later.
The study found that “consistent checklist use rose from 75% in 2002 to 100% in 2007 and beyond,” and “self-reporting of incidents rose from 709 per quarter in 2002 to 1,481 per quarter in 2008.”
Disclosures: Dr. Sax serves as a medical consultant to Indelta Learning Systems Inc., which codeveloped the CRM training; one coauthor is an Indelta employee.