The effect of crisis resource management training on error in the emergency department : a systematic review

Background Emergency department clinicians confront problems that are often ill defined, rapidly evolving and have severe consequences. The propensity for error is, therefore, significant. Crisis Resource Management training has gained recent attention as a means of improving teamwork and reducing error in the emergency department. Methods A systematic review of the literature was conducted to determine the effectiveness of Crisis Resource Management training in reducing error in the emergency department. The following databases were searched: CINAHL, EMBASE, MEDLINE, PsycINFO, PubMed Central and Google Scholar. Published and unpublished, experimental and quasi-experimental studies were considered. Relevant studies were appraised using the Joanna Briggs Institute Meta Analysis Statistics Assessment and Review Instrument. Results The literature search yielded a total of 491 published studies. After screening and critical appraisal, two studies were included. The first, a quasi-experimental before and after study, reported an 18 percent decrease in patient safety events following the intervention, which was not significant (p=0.22). The second, a quasiexperimental, non-randomised control, before and after study, reported an 85 percent decrease in observed errors following the intervention. When compared to the control group, however, this was not significant (p=0.140). Due to the number and heterogeneity of the included studies, the results were combined into a narrative synthesis rather than a meta-analysis. The review suffered from publication bias because no unpublished studies were located. Conclusion There is limited evidence that Crisis Resource Management training reduces error in the emergency department. Further research, utilising an experimental or mixed methods design should be carried out to measure the overall effectiveness of Crisis Resource Management training within the emergency department.