Application of hierarchical and progressive training in crisis resource management in anesthesiology department

Background: Effectively managing anesthesia crisis resources is important for anesthesia and surgery. Local problem: Given the diverse roles and varying levels of experience among anesthesiology personnel, it becomes challenging to enhance the emergency response capabilities of all individuals. Methods and interventions: We developed emergency plans for crisis management during the peri-anesthesia period and conducted monthly hierarchical and progressive trainings, including theory teaching, in-situ simulation, simulation teaching, and clinical practice. Moreover, stratified the members of anesthesiology department into anesthesiologists, residents, and anesthesia nurses with different training objectives. Graded assessments include theoretical assessment, simulation assessment, and clinical assessment. Results: Thirteen emergency plans have been completed. The average accuracy of theoretical assessment for 44 anesthesiologists was 92.2% ± 5.5%, 95%CI [90.5%, 93.8%]; for 28 residents, it was 93.3% ± 5.9%, 95%CI [91.0%, 95.6%]; and for 49 anesthesia nurses, it was 94.4% ± 4.2%, 95%CI [93.2%, 95.6%]. Abilities of crisis resource management improved during in-situ simulations and simulation teaching sessions; 94 cases of adverse events with successful treatment were reported, including two cases of amniotic fluid embolism, two cases of malignant hyperthermia, and one case of maternal cardiac arrest. Additionally, early detection led to the prevention of further deterioration in five cases of hysteroscopic water poisoning and 20 cases of air embolism. Furthermore, successful treatment was achieved for 17 cases presenting of perioperative anaphylaxis. Conclusion: The implementation of hierarchical and progressive training effectively enhances abilities of crisis resource management in anesthesiology department, including medical knowledge and skills, and facilitates early identification and effective management of anesthesia-related crises.