title: The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study.
abstract: OBJECTIVE
  To evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes.
  
  
  METHODS
  3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group.
  
  
  METHODS
  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.
  
  
  METHODS
  A 1-day teamwork training course for all staff, followed by 6 weeks of weekly in-service coaching to embed learning.
  
  
  METHODS
  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.
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Lauren
authors.initials: L
authors.lastname: Morgan
authors.affiliation: Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hadi
authors.affiliation: Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Pickering
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Robertson
authors.affiliation: Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
authors.forename: Damian
authors.initials: D
authors.lastname: Griffin
authors.affiliation: Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Collins
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, UK Red de Investigación de Servicios Sanitarios en Cronicidad (REDISSEC), Spain.
authors.forename: Oliver
authors.initials: O
authors.lastname: Rivero-Arias
authors.affiliation: Cedars-Sinai Medical Centre, Los Angeles, California, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Catchpole
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: McCulloch
authors.affiliation: Saïd Business School, University of Oxford, Oxford, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: New
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D004517:Education, Professional / Q000379:methods*; D017558:Elective Surgical Procedures / Q000592:standards*; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007318:Inservice Training; D065186:Interrupted Time Series Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D006113:United Kingdom
keywords: Patient safety; Quality improvement; SURGERY