Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care
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Crisis Resource Management and High‑Performing Teams in Hyperacute Stroke Care Phavalan Rajendram1†, Lowyl Notario2†, Cliff Reid3†, Charles R. Wira4†, Jose I. Suarez5†, Scott D. Weingart6† and Houman Khosravani1* © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background and Purpose: Management of stroke patients in the acute setting is a high-stakes task with several challenges including the need for rapid assessment and treatment, maintenance of high-performing team dynamics, management of cognitive load affecting providers, and factors impacting team communication. Crisis resource management (CRM) provides a framework to tackle these challenges and is well established in other resuscitative disciplines. The current Coronavirus Disease 2019 (COVID-19) pandemic has exposed a potential quality gap in emergency preparedness and the ability to adapt to emergency scenarios in real time. Methods: Available resources in the literature in other disciplines and expert consensus were used to identify key elements of CRM as they apply to acute stroke management. Results: We outline essential ingredients of CRM as a means to mitigate nontechnical challenges providers face during acute stroke care. These strategies include situational awareness, triage and prioritization, mitigation of cognitive load, team member role clarity, communication, and debriefing. Incorporation of CRM along with simulation is an established tool in other resuscitative disciplines and can be incorporated into acute stroke care. Conclusions: As stroke care processes evolve during these trying times, the importance of consistent, safe, and efficacious care facilitated by CRM principles offers a unique avenue to alleviate human factors and support highperforming teams. Keywords: Stroke, Critical care, Pandemics, Patient care team Introduction Assessment of patients with stroke for hyperacute treatments such as thrombolysis and thrombectomy must be timely, precise, and effective to achieve the best clinical *Correspondence: [email protected] † Phavalan Rajendram and Lowyl Notario Co-first authors. Cliff Reid, Charles R. Wira, Jose I. Suarez and Scott D. Weingart have been contributed equally to this work. 1 Brain Resuscitation Lab, Neurology Quality and Innovation Laboratory (NQIL), Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room H335 – 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada Full list of author information is available at the end of the article
outcomes. Stroke care has advanced significantly over the years with the emergence of new hyperacute therapies including late-window thrombectomy, advanced imaging, and the creation of systems of care. The current Coronavirus Disease 2019 (COVID-19) pandemic has exerted stress on existing stroke clinical pathways, exposing a potential quality gap in terms of emergency preparedness. This is especially poignant during the hyperacute phase as providers form ad hoc te
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