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Lessons in Flying: Crew Resource Management as a Quality Improvement Method for Acute Coronary Syndromes Care

Levy, Phillip D. MD, MPH; Dancy, JaNeen N. PharmD; Stowell, Stephanie A. MPhil; Hoekstra, James W. MD; Arthur, Crystal L. MD; Wilson, Charles H. MD; Bednar, John M. MD; Dorman, Todd MD, FCCM; Hiestand, Brian MD, MPH, FACEP

Critical Pathways in Cardiology: March 2014 - Volume 13 - Issue 1 - p 36–42
doi: 10.1097/HPC.0000000000000002
Original Article

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.

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From the *Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI; Med-IQ, Baltimore, MD; Department of Emergency Medicine, Wake Forest University Health Sciences, Winston-Salem, NC; §Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI; Department of Emergency Medicine, Cone Health and Heart Vascular Center, Greensboro, NC; and **Department of Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.

This initiative was supported by independent, unrestricted educational grants from the Bristol-Myers Squibb/Sanofi Partnership and the Daiichi Sankyo, Inc./Eli Lilly and Company Alliance. The funding sources had no role in the execution, analysis, or development of the resulting article associated with this initiative.

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Reprints: Phillip D. Levy, MD, MPH, Department of Emergency Medicine, Wayne State University School of Medicine, UHC-6G, 4201 St. Antoine, Detroit, MI 48201. E-mail:

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