CREW Resource Management is a patient safety initiative that focuses on a team centered approach to identifying and addressing potential safety concerns.  The goal at the end of the training session is not only to empower all team members to speak up if they recognize patient safety concerns but also to incorporate tools into our practice that can circumvent potential errors.  This post provides a brief overview of the tools in place in our department:

1.  Get on Board’ Patient Communication Board – in each room in the department there is a white board that is used to engage the patient in their care.  It not only serves to allow the patient care team to communicate the plan on care with the patient but also keeps the patient up to date on what studies or consultations are pending.

2.  Critical Care Debrief Tool

Why was the Critical Event Debrief was Created?   

During the Crew Skills Teaching sessions emergency department (ED) staff  (including physicians, nurses, patient care techs) identified the opportunity to debrief as a team after certain events in the ED as an area we could focus on for quality improvementand staff satisfaction.

What is the Critical Event Debrief?

There are two elements to the Critical Care Debrief.  There is a ‘moderator version’ which is a laminated card that guides the attending through the elements to be debriefed.  There is also a ‘recorder version’ which is used by the nurse to write down issues raised during the debrief and on the reverse side has a sign-in for those involved in the debrief.  Both of these forms are located in a labeled folder in area one.  At the end of the debrief both forms are returned to the folder.

When should the Critical Event Debrief be Utilized?

A debrief can be requested by any team member.  It is mandatory after resuscitations but should also be considered after any event in the ED requiring a high amount of resources or unexpected outcomes.  It should be conducted as soon after the event as possible and should not take longer than around 5 minutes to conduct.

How is the Critical Event Debrief Initiated?

Any team member can request a debrief and should bring their request to the attention of the attending physician or charge nurse who can then facilitate bringing involved team members together.

Who is Responsible for Conducting the Critical Event Debrief?

The attending physician serves as the moderator and the primary nurse is the scribe for the debrief.  All team members should be polled for any concerns at the end of each debrief.

Where is the Critical Event Debrief Held?

The debrief can be held in any location deemed suitable and available to accommodate all involved team members.

Other Notes…

• The debriefs are protected from potential medico-legal or organization ramifications as they are a quality improvement initiative protected under the Illinois Medical Studies Act.
• Each debrief can be recommended for leadership review or further discussion if deemed appropriate by team members.

3.  ED Team Huddle – the ED Team Huddle is performed at shift turnover to communicate transitions in patient care.  It is led by the charge nurse on the oncoming shift.

An Adult Resuscitation

A Pediatric Resuscitation

Psychiatric Patient

Conflicts within Team