Personnel Resources for Crisis Response

There is a problem with identifying the need for a crisis team response, which is deeply imbedded in medical care. A strict hierarchy has made the patient’s individual attending physician the “captain of the ship.” This is a great strategy for coordinating care in routine situations, but can become an obstruction to rapidly responding to changes in a patient’s status. In some clinical settings, such as the operating room or intensive care unit (ICU), this hierarchical system further adds to the potential confusion when multiple “captains” are responsible for different aspects of a single patient’s care. The problems with this hierarchical style of management stem partly from the commonly held belief that the hierarchy must be “ascended” instead of being “transcended.” For example in, a medical education model, a nurse assistant would first call the nurse, who would then call the intern, who would call the resident, who would then call the attending physician of record, with each call occurring when the individual perceived that he or she was incapable of managing the situation. A similar problem occurs in a non-educational health care setting: the nurse assistant notifies the nurse who calls the primary physician, who then calls the consultant. For a patient with sudden onset of respiratory distress, one can imagine that it could take 30 minutes or more just to contact the person best able to manage the