Crisis resource management in nonoperating room anesthesia

Area of Science:

• Anesthesiology
• Healthcare Management
• Patient Safety

Background:

• Anesthesia care is increasingly performed outside the operating room (OR) in nonoperating room anesthesia (NORA) sites, accounting for 30-50% of cases.
• NORA environments present unique challenges including patient and ergonomic complexity, unfamiliar teams, and potentially limited resources.
• These factors can complicate anesthesia delivery during both routine procedures and emergencies.

Purpose of the Study:

• To review the current evidence on crisis resource management (CRM) specifically within NORA settings.
• To identify the challenges and benefits of implementing CRM in non-traditional anesthesia locations.
• To highlight the role of simulation and team training in NORA.

Main Methods:

• Literature review of studies evaluating crisis resource management in nonoperating room anesthesia.
• Synthesis of evidence regarding team dynamics, resource availability, and training effectiveness in NORA.
• Analysis of consensus on the utility of simulation and CRM strategies.

Main Results:

• CRM in NORA involves managing care with unfamiliar teams in non-anesthesia-designed locations, often with limited or different resources.
• While direct studies on CRM effectiveness in NORA are scarce, simulation training is widely recognized for improving team behaviors, role clarity, and care timeliness.
• Well-executed CRM training can foster team building, process improvements, and the development of cognitive aids.

Conclusions:

• CRM strategies can effectively address key challenges in NORA, such as working with unfamiliar teams and in non-ideal environments.
• The limited number of studies may stem from difficulties in implementing interprofessional CRM training in high-productivity settings.
• Future research should focus on identifying barriers to NORA CRM training and effective implementation strategies.