Reducing Overcrowding during an Emergency to Improve Team Communication and Role Identification: A Quality Improvement Crowd Control Initiative

Abstract : Overcrowding during emergency events leads to poor team dynamics and communication, which negatively impacts patient safety. At this large academic medical center, an average of 27 clinicians present during an emergency event. Pre-intervention data showed that only 20% of staff reported roles were identifiable and 47% perceived team communication was clear. The purpose of this initiative was to eliminate non-essential clinicians during an emergency response to promote clear communication and role delineation. The system wide crowd control initiative was led by an interdisciplinary steering committee, including nurses, physicians, respiratory therapists, pharmacists, nurse educators and hospital leadership. The acronym VOICES (V-vitals; O-oxygen; I-intravenous access; C-crash cart; E-EKG, and S-sugar/suction) was developed to outline key nursing interventions before an emergency response team arrives. A code map was also made to illustrate role location in relation to pertinent skills. Nurses were assigned a crowd-control e-learning module to learn foundational knowledge and interdisciplinary in-situ simulations were conducted to provide an experiential learning opportunity. Debriefings was conducted after each simulation and led by trained facilitators to discuss the American Heart Association (AHA) methodology for high performance teams and TeamSTEPPS communication tools. Post intervention data, collected using an electronic post event debriefing tool, demonstrated that an average of 10 responders were present per event which resulted in a reduction of 37%. Staff reported roles were clearly identified 80% of the time and 95% stated team communication was effective. Continuing the in-situ simulations and monitoring clinical outcomes are needed to determine long term impact on patient safety.