A quality improvement initiative based on crew resource management principles improved provider knowledge and confidence in ACS care, but had limited impact on clinical performance measures.
Does a CRM-based educational QI initiative improve provider knowledge and clinical performance measures in ACS care?
A CRM-based educational program improved provider knowledge and confidence but did not translate into significant clinical process improvements for ACS care.
Providing timely, high-quality, guideline-based care to patients with acute coronary syndromes (ACS) who present to the emergency department is critically dependent on cooperation, coordination, and communication between emergency medicine physicians and cardiologists. However, to achieve sustained improvement at the individual institution level, consistent implementation of quality improvement (QI) activities is needed. We describe a QI initiative for ACS care in the emergency setting that combined clinical education with a curriculum based on crew resource management (CRM) principles-a set of tools and techniques for communication, teamwork, and error avoidance used in the aviation industry and with proven applicability in the healthcare setting. Educational training sessions were open to multidisciplinary healthcare teams at 3 hospital sites, and participants were provided practical tools and resources to enhance communication, teamwork, and patient-centered care. Through patient chart reviews, participant surveys, and clinician interviews, baseline assessments of clinical performance measures and team communication-, logistics-, and skills-based efficiencies were performed and reported before the educational training was delivered at each QI site. Reviews of pre- and postinitiative participant surveys demonstrated improvement in knowledge and confidence in the delivery of appropriate and effective ACS care; however, reviews of pre- and postinitiative patient charts revealed limited process improvements. Altogether, this multicenter study of a continuing medical education program based on CRM principles was associated with improvements in provider knowledge and confidence regarding the delivery of appropriate ACS care, but had limited impact on clinical performance measures.
Levy et al. (2014) studied Acute coronary syndromes (ACS). Quality improvement initiative based on crew resource management (CRM) principles vs. Pre-initiative baseline was evaluated on Provider knowledge, confidence, and clinical performance measures. A quality improvement initiative based on crew resource management principles improved provider knowledge and confidence in ACS care, but had limited impact on clinical performance measures.