title: Cluster randomized trial to evaluate the impact of team training on surgical outcomes.
abstract: BACKGROUND
  The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation.
  
  
  METHODS
  A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals.
  
  
  RESULTS
  Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.
  
  
  CONCLUSIONS
  Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).
authors.affiliation: Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.|Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France.|Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School.
authors.forename: A
authors.initials: A
authors.lastname: Duclos
authors.affiliation: Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Peix
authors.affiliation: Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France.|Service d'Anesthésie Réanimation Médicale et Chirurgicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: V
authors.initials: V
authors.lastname: Piriou
authors.affiliation: Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.|Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Occelli
authors.affiliation: Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Denis
authors.affiliation: Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Bourdy
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School.
authors.forename: M J
authors.initials: MJ
authors.lastname: Carty
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School.|Ariadne Labs and Harvard Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Gawande
authors.affiliation: Air France Consulting, AFM42, Chambourcy, France.
authors.forename: F
authors.initials: F
authors.lastname: Debouck
authors.affiliation: Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Vacca
authors.affiliation: Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France.|Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Lifante
authors.affiliation: Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.|Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Colin
mesh_terms: D057189:Checklist; D016000:Cluster Analysis; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007318:Inservice Training; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D010348:Patient Care Team; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013043:Specialties, Surgical / Q000193:education*