Bonner Schockraummanagement-Kurs®: Darstellung eines innerklinischen Kurskonzepts zur Schwerstverletztenversorgung

[Crew resource management in emergency centers]

The treatment of critically ill patients in the emergency room poses major challenges to the treatment teams. Good teamwork is essential for patient care and patient safety. Between 60 and 70% of all errors in high-risk areas-such as medicine-are assigned to the field of "human factors". In aviation, after several aircraft disasters, the concept of "Crew Resource Management" (CRM) was developed in the 1980s to avoid such errors and has since established itself in many high-security industries. In contrast to medicine, there has long been a legal obligation in aviation to conduct regular CRM training. Introduced into medicine by anesthesiologists in 1990 because of its potential, CRM training has so far found its way into emergency medicine especially, even without it being a legal obligation. For trauma room treatment of polytrauma patients, the disciplines involved already offer a specially developed training concept in which teaching of CRM principles is the main focus (HOTT®-Schockraumsimulation). In addition to dedicated private providers of CRM training and individual concepts developed at an institutional level, several common course concepts for the care of emergency patients also integrate CRM principles to varying degrees into their curricula and teaching methods. Level IA evidence for CRM training is still missing also due to systematic difficulties not only in medicine, but also in other high-risk areas. However, further implementation of regular CRM training in medicine should not be suspended for this very reason.

Improvement of polytrauma management-quality inspection of a newly introduced course concept

RATIONALE, AIMS, AND OBJECTIVES

A systematic literature search for training course concepts for care of severely injured and severely ill patients respecting improvement of process and outcome yielded little data. For several years, the University Hospital of Bonn has hosted a shock-room management course which, on the one hand, communicates human factor aspects and, on the other hand, pursues interdisciplinary and interprofessional team training. The Bonn shock-room management course (BSM-course®) differs from other courses in both format and principles. The aim of this study was to evaluate the quality of the structure of the course based on course evaluations of participants and its impact on the quality of the process and results for polytrauma care.

METHODS

Single-center retrospective evaluation study (2011 to 2014). It was based on data from simulator training and records from the German Trauma Registry (DGU)®.

RESULTS

Subjective evaluation of participants (n = 188) of the structure quality of Bonn's shock-room management course was overall positive. Objective measures of course participant performance also improved during simulation training (P = 0.012). An increasing number of trained employees also had a positive influence in reducing process time for shock-room care. Further, the course likewise had a positive impact on documentation quality (degree of completion), with regard to 4 relevant predictive parameters. Early mortality during the first 24 hours remained constant at 6.0-6.5% between 2011 and 2013, yet it decreased to 3.1% in 2014.

CONCLUSION

The BSM-course® represents a symbiosis of horizontal team approach of trauma care and human factor training. The course format is able to ensure interdisciplinary and interprofessional team training with a high degree of efficiency. Furthermore, the presented work shows that a modern course concept can improve the quality of trauma care.

[Hospital-based acute care of emergency patients: the importance of interdisciplinary teamwork]

BACKGROUND

The care of emergency patients with life-threatening injuries or diseases presents a special challenge to the treatment team. Good interdisciplinary cooperation is essential for fast, priority-oriented, and efficient emergency room management. Particularly in complex situations, such as trauma room care, so-called human factors largely determine the safety and performance of the individual as well as the team. Approximately 70 % of all adverse events stem from human factors rather than from a lack of medical expertise. It has been shown that 70-80 % of such incidents are preventable through special training.

OBJECTIVES

Established course concepts based on so-called ABCDE schemes are a good basis for creating algorithms for targeted therapy, yet they are not sufficient for the training of team-specific issues. For this, special course concepts are required, such as crew resource management, which is provided through simulator-based training scenarios. This includes task management, teamwork, decision-making, and communication. The knowledge of what needs to be done in a team under the adverse and complex conditions of a medical emergency must be gained by training based on realistic and effective measures.

CONCLUSION

Course concepts that are geared toward interdisciplinary and interprofessional team training optimize patient safety and care by supporting the nontechnical abilities of team members.