When a 37-year-old man in cardiac arrest showed up recently at Baptist Hospital of Miami’s emergency department, the reaction by clinicians was not heated or rushed.
A coolness permeated the room. Everyone on the team knew his or her role, and the ED physician who was leading the care didn’t hesitate to ask team members for input. Running out of options — the patient was down for 25 minutes — the doctor recapped the situation and went through the caregivers’ possible responses.
The picture is a stark contrast to a year ago, when such a situation might have spelled chaos, says Paula Barrass, assistant nurse manager of Baptist’s ED. She credits the staff’s shift in demeanor to a newly adopted technique long used by the airline industry called crisis resource management.
While the outcome didn’t change in the above situation, Barrass says, the hospital’s staff clearly had. “You can see the difference,” she says. “When you go into a Code Blue or any situation in crisis, and you have nursing and physician staff who have gone through this training, there’s a huge difference. There’s a calmness that wasn’t there before.”
The Baptist Health Patient Safety Simulation Lab allows clinicians to rehearse critical situations with lifelike mannequins, while being videotaped. In one possible scenario, a patient’s blood pressure drops drastically during a heart procedure, and the cardiac surgery team must react on the fly. Teams go through two 15-minute scenarios, with time afterward to debrief and talk about the motivations behind their reactions, Barrass says.
Use of such simulation-based training to prepare workers for crises goes back decades and first was used by the aviation industry. Stanford University anesthesiologists subsequently adapted crisis resource management to the operating room in the 1980s, and more recently, the practice has made its way into the ED, says Samuel Clarke, M.D., a researcher and assistant professor in the UC Davis Health System’s department of emergency medicine.
A recently published five-year study by Clarke and others found that simulated crisis training did, in fact, help to improve students’ nontechnical skills, such as leadership, problem solving and resource utilization.
At Baptist Hospital, it’s too early to say exactly how crisis resource management training has impacted quality in the ED. But the half-day course has proven successful enough that the 650-bed facility, part of eight-hospital Baptist Health South Florida, is looking to expand its simulation lab, along with making yearly classes mandatory for all ED personnel, says David Mishkin, M.D., a physician with both the hospital and physician outsourcing firm Sheridan.
So far, one of the biggest benefits for Baptist has been a culture shift in the department. Nurses and technicians alike have been instilled with the self-assurance to speak up and take control in a crisis situation, when the need arises, Mishkin says.
“Members of the department who aren’t physicians feel more confident taking the lead in caring for their patients in high-risk scenarios, rather than just playing secondary roles,” he says. “It’s very encouraging.”