Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care

• Published in: Neurocritical care Vol. 33; no. 2; pp. 338 - 346
• Main Authors: Rajendram, Phavalan, Notario, Lowyl, Reid, Cliff, Wira, Charles R., Suarez, Jose I., Weingart, Scott D., Khosravani, Houman
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-10-2020; Springer Nature B.V
• Subjects: Betacoronavirus; Cognition & reasoning; Cognitive ability; Cognitive load; Communication; Coronavirus Infections - epidemiology; Coronaviruses; COVID-19; Critical care; Critical Care Medicine; Decision making; Emergency medical care; Emergency preparedness; Health Resources - organization & administration; Humans; Intensive; Internal Medicine; Medicine; Medicine & Public Health; Memory; Neurology; Pandemics; Patient assessment; Patient satisfaction; Personal protective equipment; Pneumonia, Viral - epidemiology; SARS-CoV-2; Simulation; Stroke; Stroke - therapy; Teams; Viewpoint; Critical care; Stroke; Pandemics; Patient care team
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-020-01057-4

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 high-performing teams.