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Crisis Resource Management in Medicine: a Clarion Call for Change

  • Cardiology/CT Surgery (K Gist, Section Editor)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

Reliable data indicates increasing numbers of patients are harmed when receiving healthcare. The landmark paper “To Err is Human” posited that adverse events occur in the context of the complexity of systems within medicine and are not due to intentional harm. Crisis resource management (CRM) originated in aviation in 1980. CRM is defined as the cognitive, social, and personal resource skills that complement technical skills and contribute to safe task performance. It is a risk-reducing strategy utilized in aviation that has led to significant reduction in human error–related airline fatalities. CRM was adopted from commercial aviation by medicine in 1990 in an attempt to improve patient safety and reduce morbidity and mortality attributed to medical errors.

Recent findings

In the last 40 years, commercial and military aviation has standardized CRM training which has led to a track record of success in improving safety for flight crews and passengers with flight-related mortality significantly decreasing. In stark contrast, nearly 30 years of CRM training in healthcare has been highly variable in content, quality, and outcomes. In this time, the number of patient deaths attributed to medical mistakes has increased from an estimated 50,000–100,000 in 1999 to over 250,000 per year from a 2016 estimate.

Summary

It is time to reassess how CRM is being deployed in healthcare. Full CRM integration will require significant cultural and embedded organizational changes. Proficient CRM skills are a necessary, but not sufficient, condition for adverse event rate reduction: CRM should not be just what we do—it has to be a part of who we are as medical professionals.

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Authors and Affiliations

  1. The Heart Institute, Children’s Hospital Colorado, 13123 E 16th Ave, Box 100, Aurora, CO, 80045, USA

    Robert Bishop MD & Michael Carlisle MD

  2. Human Factors and Pilot Development Department, United Airlines, Chicago, IL, USA

    Carlos Porges Psy.D, ABPP & Robert Strickland BS

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Bishop, R., Porges, C., Carlisle, M. et al. Crisis Resource Management in Medicine: a Clarion Call for Change. Curr Treat Options Peds 6, 299–316 (2020). https://doi.org/10.1007/s40746-020-00215-2

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