The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study

Abstract

ObjectivesTo evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes.Setting3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group.Participants72 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.InterventionsA 1-day teamwork training course for all staff, followed by 6 weeks of weekly in-service coaching to embed learning.Primary and secondary outcome measuresWe 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.ResultsMean 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.ConclusionsTeamwork training was associated with improved non-technical skills in theatre teams but also with a rise in operative glitches.

Evaluation of a Brief Team Training Intervention in Surgery: A Mixed‐Methods Study

“…The observational results suggest associated improvements across all teams in respect to their overall NTS behaviors and the use of the WHO Surgical Safety Checklist, which the team training intervention specifically targeted. These results are encouraging, and support other similar studies 7,10,11 . Improving teamwork requires strategies that ultimately decrease the variability in teamwork processes, 24 such as patient check in and time out.…”

“…Although teamwork training using simulation is considered useful in improving NTSs, 19 there are barriers to its implementation in large perioperative departments. The notable challenges with adopting hospital‐based NTS training programs in the OR department include limited viability given the need to meet surgical targets (ie, production pressure); engaging participants in the delivery of training programs using innovative methods; realizing demonstrable differences in teamwork behaviors, which may indirectly affect performance efficiencies; and scheduling the training, which requires considerable investment in time and effort to ensure interdisciplinary representation 7,10 …”

“…scheduling the training, which requires considerable investment in time and effort to ensure interdisciplinary representation 7,10 …”

Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises

“…Consequently, practising effective NTS, such as leadership, communication and situation awareness, has been recognized as an essential competency that can minimize avoidable error in the operating theatre. Teaching and debriefing NTS have also been shown to improve error rates within the operating theatre and are applicable to all perioperative specialties. However, despite a groundswell of opinion that NTS are important to team performance and surgical quality, quantifying how the NTS of both surgeons and anaesthetists influence outcomes has not been well established.…”

Diagnosing barriers to safety and efficiency in robotic surgery

“…The measurement of surgical FDs is sensitive to different intraoperative technologies, surgical errors (Wiegmann et al 2007), surgical experience (Catchpole et al 2015; Tang et al 2004) and the effectiveness of the supporting team (Mishra et al 2008; Morgan et al 2015a; Robertson et al 2014). In essence, the small, irregular deviations from optimal care are artefacts of processes that provide a ‘window on to the system’ to understand where the resilience required for normal system function has momentarily failed, with recurrent problems suggesting particular fragility or mismatches between goals and work system configuration.…”