29 July 2014

Use Crew Resource Management to Prevent Errors in the Operating Room

In a previous post, we discussed the cost of human error in the OR and the benefits of using Crew Resource Management (CRM) to improve communications. Despite these benefits, physicians can still be reluctant to embrace change and participate in process improvements. In these situations, buy-in from hospital executives and physician department chairs play a key role in embracing and introducing CRM to the operating room.

Address Concerns with Facts
An initial concern of surgeons and anesthesiologists is that the briefing phase will add time in the operating room at the end of each surgery. In a study of more than 37,000 cases in a large medical center, it was found that debriefing took an average of 2.5 minutes to complete, yet this time was recouped in the areas of surgery preparation and performance. Some hospitals found that debriefing actually makes surgeries more efficient and takes less time overall because less time is spent leaving the sterile field to acquire additional instruments or to assemble equipment.

Break Down Traditional Roles
Achieving egalitarianism in the operating suite is another challenge for hospitals. Typical operating room settings have an uneven power structure in which the surgeon is in charge and the medical staff is there to support the surgeon’s role. However, this approach is one-sided and goes against CRM principles. Hospital management’s commitment to the quick resolution of problems and sticking to the processes standardized by CRM will break down these traditional roles and mindsets that are detrimental to patient health and safety.

Results
When an OR department embraces CRM, the results include improvements to quality of patient care and safety. Hospitals across the nation using CRM have reported: 

  • Reduction in untoward outcomes and sentinel events 
  • Discovery of errors that previously would have gone unrecognized 
  • Prevention of wrong-side surgeries 
  • Prevention of potential medication errors Reduction of serious safety events 
  • Reduction in the three-year Mortality Index 

Our leadership brief on reducing human error in the operating room outlines the benefits of CRM and includes the steps for successfully implementing it.