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VHA National Center for Patient Safety


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Clinical Team Training


A nurse and a doctor with a patient in an operating room.The Clinical Team Training (CTT) program creates an opportunity to improve patient safety and reduce the risk of patient harm by facilitating clear and timely communication through collaborative teamwork in the clinical workplace.

Aimed at a multi-disciplinary group of front-line VHA health care providers, NCPS program is based on techniques used in aviation’s Crew Resource Management (CRM) training.

CRM was implemented by the airline industry in the early 1980s after a series of highly publicized accidents resulted not from mechanical malfunctions, but from poor communication and team decision making. Today, the airlines enjoy an exemplary safety record, due in large part to the implementation and sustainment of CRM methodologies.

Problems in health care are not unlike the problems that plagued the airlines decades ago. For instance, communication failure is a leading source of adverse events in health care. “Insufficient communication” was the most frequently cited root cause of the nearly 3,000 sentinel events reported to the Joint Commission between 1995 and 2004.

Joint Commission statistics*† (2004-2013) indicate that approximately 70 percent of the time communication failures continue to be cited as a major root cause in reported sentinel events.

CTT has demonstrated effectiveness in the clinical environment. A VA study conducted in 2010 and published in Journal of the American Medical Association found a significant decrease in the annual surgical mortality rate in groups trained in CTT methods, as opposed to untrained groups.

The 74 facilities in the training program experienced an 18 percent reduction in annual mortality compared with a 7 percent decrease among the 34 facilities that had not yet undergone training. It was also noted that the longer these methods had been practiced at a medical facility, the greater the decrease in mortality.

Two other studies published in the Archives of Surgery in 2011 showed further positive results from the use of CTT methods, such as a significant decrease in the rate of adverse events and the severity of those events in the operating room.

CTT methods were also used to improve communication and teamwork on 11 nursing units at nine VA facilities during another training program piloted in 2010, which included a six-hour learning session and two-hour clinical simulations using high-fidelity patient simulators.

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Selected Publications

  • Paull, D.E., et al (2013). The effect of simulation-based crew resource management training on measurable teamwork and communication among inter-professional teams caring for postoperative patients. Journal of Continuing Education in Nursing, 44(11): 516-524.
  • West, P., et al. (2012). Improving Patient Safety and Optimizing Nursing Teamwork using Crew Resource Management Techniques. The Journal of Nursing Administration, 42(1), 15-20.
  • Neily, J., et al. (2011). Incorrect Surgical Procedures Within and Outside of the Operating Room A Follow-up Report. Archives of Surgery, 146(11), 1235-1239.
  • Young-Xu, Y., et al. (2011). Association between implementation of a medical team training program and surgical morbidity. Archives of Surgery, 146(12), 1368-1373.
  • Neily, J., et al. (2010). Association between implementation of a medical team training program and surgical mortality. Journal of the American Medical Association, 304(15):1693-1700.

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