title: A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study.
abstract: BACKGROUND
  Teamwork training and system standardisation have both been proposed to reduce error and harm in surgery. Since the approaches differ markedly, there is potential for synergy between them.
  
  
  METHODS
  
  
  
  METHODS
  Controlled interrupted time series with a 3 month intervention and observation phases before and after.
  
  
  METHODS
  Operating theatres conducting elective orthopaedic surgery in a single hospital system (UK Hospital Trust).
  
  
  METHODS
  Teamwork training based on crew resource management plus training and follow-up support in developing standardised operating procedures. Focus of subsequent standardisation efforts decided by theatre staff.
  
  
  METHODS
  Paired observers watched whole procedures together. We assessed non-technical skills using NOTECHS II, technical performance using glitch rate and compliance with WHO checklist using a simple quality tool. We measured complication and readmission rates and hospital stay using hospital administrative records. Before/after change was compared in the active and control groups using two-way ANOVA and regression models.
  
  
  RESULTS
  1121 patients were operated on before and 1100 after intervention. 44 operations were observed before and 50 afterwards. Non-technical skills (p=0.002) and WHO compliance (p<0.001) improved significantly after the intervention in the active versus the control group. Glitch count improved in both groups and there was no significant effect on clinical outcomes.
  
  
  CONCLUSIONS
  Combined training in teamwork and system improvement causes marked improvements in team behaviour and WHO performance, but not technical performance or outcome. These findings are consistent with the synergistic hypothesis, but larger controlled studies with a strong implementation strategy are required to test potential outcome effects.
authors: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors: Lauren
authors: L
authors: Morgan
authors: Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
authors: Sharon P
authors: SP
authors: Pickering
authors: Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
authors: Mohammed
authors: M
authors: Hadi
authors: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors: Eleanor
authors: E
authors: Robertson
authors: Saïd Business School, University of Oxford, Oxford, UK.
authors: Steve
authors: S
authors: New
authors: Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
authors: Damian
authors: D
authors: Griffin
authors: Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
authors: Gary
authors: G
authors: Collins
authors: Nuffield Department of Population Health, University of Oxford, Oxford, UK Red de Investigación de Servicios Sanitarios en Cronicidad (REDISSEC), Spain.
authors: Oliver
authors: O
authors: Rivero-Arias
authors: Cedars-Sinai Medical Centre, Los Angeles, USA.
authors: Ken
authors: K
authors: Catchpole
authors: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors: Peter
authors: P
authors: McCulloch
mesh_terms: D057189:Checklist / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D006801:Humans; D065186:Interrupted Time Series Analysis; D007902:Length of Stay; D019300:Medical Errors / Q000517:prevention & control; D009873:Operating Rooms / Q000458:organization & administration / Q000592:standards; D019637:Orthopedic Procedures / Q000379:methods / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards
keywords: Patient Safety; Quality Improvement; Surgery; Team Training