Morgan, Lauren J., Hadi, Mohammed, Pickering, Sharon, Robertson, Eleanor, Griffin, Damian R., Collins, Gary S., Rivero-Arias, Oliver, Catchpole, Ken, McCulloch, Peter and New, Steve (2015) The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery : a controlled interrupted time series study. BMJ Open, Volume 5 (Number 4). pp. 1-8. Article number e006216. doi:10.1136/bmjopen-2014-006216 ISSN 2044-6055.

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Abstract

Objectives:
To evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes.

Setting:
3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group.

Participants:
72 operations (37 intervention, 35 control) were observed in full by 2 trained observers during two 3-month observation periods, before and after the intervention period.

Interventions:
A 1-day teamwork training course for all staff, followed by 6 weeks of weekly in-service coaching to embed learning.

Primary and secondary outcome measures:
We measured team non-technical skills using Oxford NOTECHS II, (evaluating the whole team and the surgical, anaesthetic and nursing subteams, and evaluated technical performance using the Glitch count. We evaluated compliance with the WHO checklist by recording whether time-out (T/O) and sign-out (S/O) were attempted, and whether T/O was fully complied with. We recorded complications, re-admissions and duration of hospital stay using hospital administrative data. We compared the before–after change in the intervention and control groups using 2-way analysis of variance (ANOVA) and regression modelling.

Results:
Mean NOTECHS II score increased significantly from 71.6 to 75.4 in the active group but remained static in the control group (p=0.047). Among staff subgroups, the nursing score increased significantly (p=0.006), but the anaesthetic and surgical scores did not. The attempt rate for WHO T/O procedures increased significantly in both active and control groups, but full compliance with T/O improved only in the active group (p=0.003). Mean glitch rate was unchanged in the control group but increased significantly (7.2–10.2/h, p=0.002) in the active group.

Conclusions:
Teamwork training was associated with improved non-technical skills in theatre teams but also with a rise in operative glitches.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Orthopedics, Health care teams -- Training of
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	20 April 2015
Dates:	Date Event 20 April 2015 Published 22 December 2014 Accepted 30 July 2014 Submitted
Volume:	Volume 5
Number:	Number 4
Number of Pages:	8
Page Range:	pp. 1-8
Article Number:	Article number e006216
DOI:	10.1136/bmjopen-2014-006216
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	29 December 2015
Date of first compliant Open Access:	29 December 2015
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	RP-PG-0108-10020 (NIHR)

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