Crew Management Processes Revitalize Patient Care
- Sunday, 01 November 2009
Cardiologist Drew Gaffney flew as a payload specialist in 1991 on STS-40, the first Spacelab mission dedicated to biomedical studies. On the mission, he worked with fellow physician and astronaut Rhea Seddon. Seddon became an astronaut in August 1979 and ultimately spent 722 hours in space, acting as a mission specialist on STS-51D (1985) and STS-40, and then as payload commander on STS-58 (1993). NASA prepared Seddon and Gaffney for both routine and emergency situations in their missions through extensive CRM skill training and LOFT simulations. In 2005, Seddon and Gaffney collaborated with two former FedEx Corporation CRM trainers and U.S. Navy top gun pilots, Steve Harden and Alan Mullen, to found LifeWings Partners LLC, based in Memphis. The LifeWings founders had realized the medical industry was a natural fit for NASA’s CRM and could benefit from techniques that helped crews function in stressful, fast-paced environments.
Situational awareness, peer monitoring, simulation training, and procedural checklists have long been a part of NASA’s astronaut training, and the LifeWings partners discovered the need for these same tools in medicine. In medicine like with space missions, Gaffney explains, “There was a lot of routine, but a lot of stress. Decisions were high-consequence.” As a result, LifeWings designed an approach to help hospitals use the same cockpit training and tools that had been so useful in making commercial aviation safe and reliable. LifeWings provides customized, in-depth CRM training to health care teams, which begins with onsite evaluations and focus groups, progresses with customized realistic simulations and extensive training in CRM techniques, and concludes with team assessments and interviews.
One skill that LifeWings stresses in its training is situational awareness. Doctors, nurses, and other hospital staff learn to notice subtle changes in their surroundings and to check in regularly with teammates. Gaffney explains that the LifeWings CRM training helps “create a culture that is psychologically and administratively safe,” so that any employee can spot and report potential hazards without fear. Everyone shares responsibility for patient safety, and having team accountability works far more effectively than individual accountability alone. This ongoing peer monitoring helps eliminate costly (and sometimes dangerous) medical mistakes, such as duplicating the administration of a drug, because everyone is aware of what a teammate is (or is not) doing. Gaffney says, “Because of their CRM training, if there is any confusion, everyone is expected to speak up and raise a concern,” intervening with clearly stated questions or observations. Using good CRM, another teammate or the team leader acknowledges the question and responds; the added information and teamwork protect the patient from avoidable errors. Eventually, this cycle becomes routine and part of the culture, resulting in significant reduction in medical errors. Vitabot has nearly 1,000 company clients and has experienced over 1,500-percent growth in the health club industry. LifeWings uses simulations to evaluate new clients and see how their health care teams respond to different stressful situations, such as staff or room shortages, procedural bottlenecks, and various patient emergencies. These simulations help LifeWings identify focus areas for training or re-training, enabling the company to improve efficiency in both emergencies and routine procedures, such as getting a patient’s results from a hospital laboratory or reducing waiting times. Health care teams, like astronaut crews, benefit from rehearsing responses to realistic situations, and after being trained in CRM, the crews are better able to follow proper procedures, regardless of the situation.
Research published in January 2009 in The New England Journal of Medicine describes how doctors using a simple checklist before surgery were able to reduce post-surgical deaths by more than 36 percent. According to LifeWings president Steve Harden, when hospitals follow the LifeWings CRM training, they have seen major improvements, such as in risk-adjusted patient mortality. Harden explains, “We’ve seen decreases from 1.2 to 0.68,” in observed to expected deaths, indicating an almost 50-percent improvement.
Focus group interviews performed by LifeWings indicated medical staff felt, after CRM training, they had better teamwork, less waste, greater efficiency, and better overall patient outcomes. The LifeWings data showed 51-percent improvement in operating room turnaround, 40-percent decrease in post-operative infections, and vast improvements in team members’ willingness to speak out about possible problems and advocate for patient safety. Hospital administrators also note that the LifeWings CRM training seems to improve employee satisfaction, reduce patient stays and time in routine procedures, and reduce employee turnover.