///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Name/Claim/Aim for Obstetric Crises: A New Paradigm in Crisis Resource Management

Abstract Number: T1I-481
Abstract Type: Original Research

Rebecca D Minehart MD, MSHPEd1 ; Jenny W Rudolph PhD2; Robert L. Nadelberg MD3; Erik M. Clinton MD4; Roxane Gardner MD, MSHPEd, DSc5

Scope of Problem:

Obstetric emergencies occur infrequently [1], but require organized application of crisis resource management (CRM) principles to facilitate teamwork and provide optimal care [2]. Despite detailed knowledge of CRM principles introduced decades ago [3], it is challenging to recall and apply these high-level concepts during a stressful maternal and fetal crisis. At the Center for Medical Simulation (CMS) (Boston, MA), we sought to create an easy-to-remember mnemonic that incorporated all 11 CRM principles for use in interprofessional obstetric simulation training, along with a robust teamwork theoretical base.

CRM Mnemonic Creation:

The 11 CRM principles incorporated were: 1) Call for help early, 2) Anticipate and plan, 3) Know the environment, 4) Use all available information, 5) Allocate attention wisely, 6) Mobilize resources, 7) Use cognitive aids, 8) Communicate effectively, 9) Distribute the workload, 10) Establish role clarity, and 11) Designate leadership. We sought to underscore the importance of psychological safety and fostering speaking up in our diverse groups, which would maximize input and distributed leadership throughout the management of a crisis. Therefore, we promoted the role of an “Event Manager,” someone designated to encourage team organization as well as updated communication and input from the team. In addition, we encouraged group members to hold a “Basic Assumption” about each other, that everyone was attempting to do his or her best work.

To minimize cognitive load under stress, we focused our creation on an easy-to-remember mnemonic, into which we incorporated all 11 CRM principles into a Pre-Name phase, and then to “Name/Claim/Aim” to facilitate: 1) “Naming” the clinical problem out loud; 2) “Claiming” the role of “event manager” and asking others to state their roles; and 3) “Aiming” the team with a brief list of interventions. The Pre-Name phase incorporates knowing the environment, anticipating and planning, and calling for help early. The “Name” phase includes effective communication, anticipating and planning, and mobilizing resources. The “Claim” phase is the most extensive, and includes all CRM principles except those included in Pre-Name. We included a cognitive aid of suggested roles for teams to fulfill. The “Aim” phase includes effective communication, mobilizing resources, using all available information, and using cognitive aids.

Application:

“Name/Claim/Aim” has been adopted into formalized simulation training at Massachusetts General Hospital, and into our Emergency Manuals located throughout. Further research will target clinical outcomes. By streamlining CRM principles to promote recall and application, we hope to further best team practices during obstetric crises.

References:

1. Schornack LA, et al. Curr Opin Anaes 2017; 30: 723-9.

2. Weaver SJ, et al. BMJ Qual Saf 2014; 23: 359-72.

3. Gaba D, et al. Crisis Management in Anesthesiology, 2nd ed. Saunders, 2014.

SOAP 2019