VA PA Sim Center

Crisis Resource Management Training in the Intensive Care Unit

Eran Geller, MD+
Juliana Barr, MD+
Geoff Lighthall, MD, PhD
Edward Bertaccini, MD+
Joni Dirks, RN+
Fausto Perez, RT+
David Gaba, MD*
Steve Howard, MD*
Yasser Sowb, PhD*
Erin Bushell, MD*

+Intensive Care Unit
*Simulation Center for Crisis Management Training in Health Care
Department of Anesthesiology
VA Palo Alto Health Care System
Stanford University School of Medicine

Subjective Assessment of ACRM-LIKE Training for Hospital ICU Personnel
Presented at the 2002 International Anesthesia Research Society Meeting


Anesthesia Crisis Resource Management training (ACRM) extends crew resource management (CRM) training developed for commercial pilot training into anesthesia1, 2. At the VAPAHCS, we developed an ACRM-like program to train the hospital’s housestaff and others on crisis resource management skills for improving the management of patient emergency situations (IMPES) on wards and ICUs. This abstract summarizes the course participants’ evaluations of the course.


The program is based on the teaching of ACRM principles like resource utilization, leadership, and communication. It included a one-hour didactic session introducing these principles and providing a group exercise on applying the principles to a patient emergency situation. 7-10 days later, a half-day simulator session followed during which the participants were divided into two combined teams of 3-4 housestaff, 1-2 nurses, and a respiratory therapist. Each team participated in one of two scenarios followed by a detailed debriefing session. At the end of each course, the participants evaluated the course by filling anonymous questionnaires.


11 courses have been held with 89 participants. Table 1 shows the different clinical domains of the participants.

Table 1


96% of the participants felt that the knowledge gained about crisis management will be helpful in their practice and 94% of the participants agreed that the course will help them practice more safely. 97% of the participants thought that the debriefing session clarified important crisis management issues and 98% thought that debriefing added to their learning experience. 89% of the participants thought that monitoring and gas delivery equipment functioned well during the simulation scenario and 74% thought the simulator session is a useful way to evaluate clinical equipment.


It is difficult to assess quantitatively the contribution of ACRM-based training programs to patient safety. Previous subjective assessments of such training programs by the trainees suggest benefits in cognitive skills for crisis management, leadership, and self-confidence, improving their clinical practice. Participants' evaluations of the IMPES program support such findings. We feel that crisis management training is important not only for anesthesia/OR personnel but also for hospital-based clinicians who sometimes are faced with difficult patient emergency situations on wards and ICUs. The resources available for managing such situations are often limited. Developing and implementing IMPES as part of housestaff training is costly in terms of both faculty and housestaff time since scheduling this training is difficult.


1. Crisis Management in Anesthesiology. New York, Churchill Livingstone, 1994.

2. Anesthesia Crisis Resource Management Training: Teaching Anesthesiologists to Handle Critical Incidents. Aviation, Space, and Environmental Medicine 63:763-770,.1992.

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