Crisis resource management

Crisis resource management

1. In the early 1990s, the concept of Anesthesia Crisis Resource Management was introduced by Dr David Gaba. It was adapted from the aviation industry and their Crew (originally “cockpit”) Resource Management principles and has extended to other specialties and fields under the name of Crisis Resource Management (CRM). CRM is a strategy to optimally identify, organize, and apply resources to preserve safety and acceptable outcomes for patients. CRM key principles were designed for team members to focus their attention on elements that can improve patient safety. See Table 9.2 for more details.
2. A simple mnemonic “Name/Claim/Aim High” integrates key CRM principles (see Figure 9.1):
   1. Name: The clinical problem/crisis must be identified and called out loud, including when the diagnosis is unknown.
      

      Figure 9.1 Name/Claim/Aim.

      This is an example of a tool to guide effective leadership, teamwork, and application of crisis resource management principles.

      (© Center for Medical Simulation, 2018.)

   2. Claim: A leader must be established, and other roles must be assigned (either leader- or self-designated; roles may change).
   3. Aim: The team is aimed with a brief list of interventions, including diagnostic questions to resolve.
3. Under this strategy, a “Pre-Name” phase includes knowing the environment, anticipating and planning, and calling early for help. The naming phase includes effective communication, anticipating and planning, and mobilizing resources. The Claiming phase is the most extensive, as it incorporates all the other principles except for those included in the pre-name phase. The term “event manager” is often used interchangeably with “team leader,” as a means to facilitate “speaking up” by team members by flattening power hierarchy. Finally, the Aiming phase encompasses effective communication, mobilizing resources, using all available information, and using cognitive aids.