Crisis Resource Management in the Emergency Department

Introduction

The healthcare fraternity falls into the high-risk category undergoing a crisis in managing patients effectively, and often, specialties like emergency medicine and anesthesiology face problems in effective treatment strategies amidst challenges like scarcity of resources and manpower, diagnostic complexities, lack of coordination, and chaotic work environments. To tackle these commonly encountered challenges, a coordinated team-based approach is required. In the late 1980s, the healthcare industry realized the importance of crisis resource management, and the Department of Anesthesiology was the first one to train its clinicians in the field of crisis resource management.

What Is Crisis Resource Management (CRM)?

Crisis resource management (CRM) works by enforcing the methods or measures that encourage the development of cognitive skills among health professionals apart from medical and technical knowledge and improve interprofessional attitudes, harnessing the optimum teamwork in delivering effective and efficient treatment strategies.

What Are the Objectives Of Crisis Resource Management (CRM)?

• To inculcate the importance of teamwork in addressing the crisis when dealing with emergency or casualty situations.

• Educating health professionals in the early detection of potential complications and encouraging timely intervention backed with interprofessional communication skills benefitting better treatment outcomes.

What Are the Principles of Effective Crisis Resource Management?

1. Leadership:

• To practice effective crisis resource management, the team requires good leadership.

• The leader shares the specific tasks among the team members to distribute the workflow in order to prevent confusion and make sure the procedure is carried out smoothly.

• Leaders should have a wide perspective in managing a condition.

• They should be skilled enough to understand the graveness of the situation and manage such cases by showing a willingness to adapt and act swiftly to avoid potential complications.

• Leaders should encourage team members to share each others’ views in the team, enabling every person to be actively involved in decision-making, which forms an integral part of a good collaborative team.

• Team members should strive to work for the better performance of the team in crisis management by understanding the motto of the team, realizing the individual’s role, and being actively involved in all the roles entrusted.

2. Communication Skills:

• One of the most common causes of medical crises is due to lack of interprofessional communication.

• For the success of any strategy devised, communication plays an important role, and it should be clear, simple, and time-bound.

• Closed-loop communication should be the main mode of practice so that the messages are delivered properly.

• A bi-directional mode of communication is encouraged, which can deliver both knowledge-based and inquiry data.

3. Plan of Action:

• Often, emergency department staff deal with sudden and complicated consequences that may negatively impact patient outcomes and medical team efficiency.

• Devising an anticipated emergency treatment plan and thinking beyond the situation can help manage the impending crisis.

• A plan of action should be devised well before an emergency condition, soon before planning a high-risk emergency situation or during a crisis.

• An effective team should carry out an action plan to prioritize work, decrease unnecessary stress and anxiety in the workplace, and efficiently perform patient care.

4. Utilization of Resources:

• For effective crisis management, the medical team needs to have access to necessary resources and their utilization. The utilization of resources mainly depends on the time of admission and the clinician's expertise.

• Due to the chaotic conditions, many times, the routine resources present can be overlooked, leading to more stress and anxiety. Thus, the team needs to have a periodic check of the availability of the instruments and resources.

• The complexity of the crisis encountered will dictate the mobilization of resources.

• The team should coordinate with each other to summon additional resources well in advance in case of an impending medical crisis to harness better patient outcomes.

5. Workload Distribution.

• A sudden shooting up of a medical crisis can leave all the team members submerged in a lot of work.

• The distribution of workload is critical as it may hamper the coordination of the team and result in ineffective crisis management.

• Hence, the workload distribution should be done among the team members to carry out a hassle-free procedure and plan the work distribution well in advance, even before the high-risk procedure fetches better results.

• However, pre-planning alone will not suffice as newer tasks get added while dealing with the emergency procedure.

• The team leader plays an important role in distributing various tasks among team members and should monitor the teams, and redistribution of work is initiated in case of large work volume.

6. Analyzing the Situation:

• Having situational awareness helps in the effective management of the crisis, which comprises judging the capacity of the current situation, devising strategies, and evaluating its impact on the present crisis management and also in the near future.

• Having a situational analysis during the management of a medical crisis will aid in timely intervention and recognize the sudden changes that require immediate medical care.

• During a crisis, constant communication within the team is encouraged regarding an adequate situational analysis based on the latest information available.

• This will make the team proactive rather than reactive when dealing with the crisis.

7. Triage and Prioritization:

• Medical crises usually manifest as an imbalance between the available resources and the work to be done utilizing those resources.

• Medical teams should understand the importance of each task and prioritize according to the patient's needs.

• In casualty setups like emergency medicine and trauma care, multiple patients are managed at a time, and triage protocols need to be carried out to save as many lives as possible.

8. Effective Management of the Disparities:

• Teams must profess the skills in differentiating the disruptions that often are encountered during the medical crisis and prioritize the ones that require immediate intervention.

• Once the priority task is identified, adequate resources for carrying out the task need to be delegated.

• Distractions from individuals tend to highly interfere with the duties and may lead to escalation. Hence, a careful assessment of the situation is made, and the people should be reassured that all their needs will be met once the crisis is resolved.

How Does Crisis Resource Management Affect Clinical Outcomes?

• CRM training in recent times has gained widespread accreditation and has become a crucial part of the healthcare delivery system.

• Recent studies have proved that acquiring crisis management skills and applying them in emergencies is associated with improved patient outcomes.

Conclusion

Team-based work plays a crucial role in effective crisis management. Patient safety and better treatment outcomes can be expected if the medical crisis is addressed effectively. Crisis resource management consists of appropriate teamwork guidelines to tackle the various challenges encountered during the management of medical crises. Hence, CRM training and workshops should be conducted frequently to train and familiarize healthcare professionals with the dynamic medical crisis situation and to tackle the crisis effectively and efficiently.