92 - Application of Crew Resource Management to Reduce Retained Surgical Items

Description: Problem Identification

Retained surgical items (RSIs) are a preventable, serious sentinel event that occurs in the perioperative period, often due to communication failure, hierarchical resistance, and lack of inclusivity within the surgical team. Inequitable outcomes may ensue if some team members do not speak up because of unconscious prejudice, cultural factors, or perceived power structures

Team Description

This initiative was guided by a multidisciplinary team of perioperative nurses, surgeons, surgical technologists, and anesthesia providers. The team members reflected a range of professional disciplines, levels of experience, genders, and cultures to reflect both the workforce and the diverse patient population being treated.

Preparation and Planning

The team conducted a gap analysis in accordance with the AORN Guideline for Team Communication (2024) and the Guideline for Prevention of Retained Surgical Items (2024). While counting processes were compliant to policy, staff response was that not all members of staff were prepared to report discrepancies or issues, especially junior staff and members of underrepresented groups. Crew Resource Management (CRM), an operational system taken from the field of aviation that is concerned with reducing hierarchy, situational awareness, and inclusive communication, was seen as a way of bridging these gaps.

Assessment

Staff debriefs and surveys highlighted differences in psychological safety perceptions by demographics and role. Minority and junior employees were less likely to speak up about counts or challenge discrepancies observed. Incident review confirmed that breakdowns led to a number of near-miss RSI incidents.

Implementation

Staff implemented CRM principles through targeted education, emphasizing closed-loop communication, situational awareness, and respectful challenge. Simulation training allowed employees to practice applying CRM skills in high-stress scenarios, recalling that every team member's voice is important and helps ensure patient safety. Training materials were based on AORN Guidelines and supplemented with position statements that promote diversity and inclusive team culture.

Outcome

Surveys post-intervention showed improved measures of psychological safety and inclusion. Staff were more willing to voice concerns, and near-miss reporting improved, showing greater awareness and watchfulness. There were no reported RSIs six months post-implementation.

Implications for Perioperative Nursing

This project shows that implementing CRM in practice, consistent with AORN Guidelines, can foster inclusive communication, reduce unconscious bias, and improve patient safety by preventing RSIs. Supporting a diverse workforce in feeling safe to speak up optimizes teamwork and outcomes for all patients.

Learning Objectives
Explain how Crew Resource Management improves team communication and reduces RSIs.
Discuss methods for creating an inclusive, psychologically safe perioperative team climate.
List relevant AORN Guidelines that support RSI prevention and inclusive communication methods.

References
AORN Guidelines for Perioperative Practice, "Team Communication," 2024.
AORN Guidelines for Perioperative Practice, "Prevention of Retained Surgical Items," 2024.