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The SCReaM programme, originally coined Surrey Crisis Resource Management (SCReaM), began in 2013 when two anaesthetists identified that during emergency situations key lifesaving treatment steps are often omitted because human memory and performance (physically and cognitively) is negatively affected in stressful situations. In 2015 in collaboration with Ashford & St Peter’s Hospitals NHS Foundation Trust, Orchard Team Solutions, and the University of Surrey, the Royal Surrey NHS Foundation Trust (RSFT) developed and introduced the first set of UK Emergency Theatre Prompt Cards for operating theatres. These cards were supported with the introduction of Team Resource Management (stemmed from aviation's Crew Resource Management (CRM)) multidisciplinary training available to all theatre healthcare workers. The training programme aimed to improve:

  • Team performance

  • Staff wellbeing 

  • Patient safety

In December 2018, the training programme was redesigned to enable the RSFT to introduce a rolling training programme thus protecting against knowledge atrophy, whilst also ensuring staff could regularly receive up-to-date knowledge and skills in HF and TRM.


As the same time, a method to capture the translation of learning into practice, known as a ‘pledge’, was developed. Pledges involve each delegate using one simple tool or technique they learnt on the course and applying it to something small in their micro/meso work system that they can improve. It utilises the quality improvement (QI) methodology of PDSA (Plan-Do-Study-Act) to enable staff to try something, learn from it, and adapt it, as required.

Pledges that started emerging highlighted that issues identified were not solely related to TRM, but to the interaction of a number of elements within a system. It became evident that staff needed more than just TRM training; being taught the lessons learned from aviation was simply not enough for improving performance and safety in such a complex adaptive environment. Only by enabling staff to understand themselves, and their interactions with colleagues and the systems in which they work, can they start to improve their own wellbeing and safety and that of their patients.

Consequently, the scope of SCReaM changed to what is it today.

A Potted History

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