A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study
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 Design: Controlled interrupted time series with a 3 month intervention and observation phase...
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| Veröffentlicht in: | BMJ quality & safety 2015-02, Vol.24 (2), p.111-119 |
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| container_title | BMJ quality & safety |
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| creator | Morgan, Lauren Pickering, Sharon P Hadi, Mohammed Robertson, Eleanor New, Steve Griffin, Damian Collins, Gary Rivero-Arias, Oliver Catchpole, Ken McCulloch, Peter |
| description | 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 Design: Controlled interrupted time series with a 3 month intervention and observation phases before and after. Setting: Operating theatres conducting elective orthopaedic surgery in a single hospital system (UK Hospital Trust). Intervention: 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. Measures: 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 |
| doi_str_mv | 10.1136/bmjqs-2014-003204 |
| format | Article |
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Since the approaches differ markedly, there is potential for synergy between them. Methods Design: Controlled interrupted time series with a 3 month intervention and observation phases before and after. Setting: Operating theatres conducting elective orthopaedic surgery in a single hospital system (UK Hospital Trust). Intervention: 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. Measures: 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. Discussion 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.</description><identifier>ISSN: 2044-5415</identifier><identifier>EISSN: 2044-5423</identifier><identifier>DOI: 10.1136/bmjqs-2014-003204</identifier><identifier>PMID: 25053827</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Aviation ; Bias ; Checklist - utilization ; Clinical outcomes ; Data collection ; Education, Medical, Continuing ; Health administration ; Humans ; Interrupted Time Series Analysis ; Intervention ; Length of Stay ; Medical Errors - prevention & control ; Operating Rooms - organization & administration ; Operating Rooms - standards ; Orthopedic Procedures - methods ; Orthopedic Procedures - standards ; Patient Care Team - organization & administration ; Patient Care Team - standards ; Patient safety ; Resource management ; Studies ; Teamwork ; Theater ; Time series ; Training ; Variance analysis</subject><ispartof>BMJ quality & safety, 2015-02, Vol.24 (2), p.111-119</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b399t-ede8b9b67c055f08ce51dbda56d3b31256d8df47f32e46aa6fc58eb270cbeb533</citedby><cites>FETCH-LOGICAL-b399t-ede8b9b67c055f08ce51dbda56d3b31256d8df47f32e46aa6fc58eb270cbeb533</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://qualitysafety.bmj.com/content/24/2/111.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://qualitysafety.bmj.com/content/24/2/111.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23552,27903,27904,77346,77377</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25053827$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morgan, Lauren</creatorcontrib><creatorcontrib>Pickering, Sharon P</creatorcontrib><creatorcontrib>Hadi, Mohammed</creatorcontrib><creatorcontrib>Robertson, Eleanor</creatorcontrib><creatorcontrib>New, Steve</creatorcontrib><creatorcontrib>Griffin, Damian</creatorcontrib><creatorcontrib>Collins, Gary</creatorcontrib><creatorcontrib>Rivero-Arias, Oliver</creatorcontrib><creatorcontrib>Catchpole, Ken</creatorcontrib><creatorcontrib>McCulloch, Peter</creatorcontrib><title>A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study</title><title>BMJ quality & safety</title><addtitle>BMJ Qual Saf</addtitle><description>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 Design: Controlled interrupted time series with a 3 month intervention and observation phases before and after. Setting: Operating theatres conducting elective orthopaedic surgery in a single hospital system (UK Hospital Trust). Intervention: 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. Measures: 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. Discussion 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.</description><subject>Aviation</subject><subject>Bias</subject><subject>Checklist - utilization</subject><subject>Clinical outcomes</subject><subject>Data collection</subject><subject>Education, Medical, Continuing</subject><subject>Health administration</subject><subject>Humans</subject><subject>Interrupted Time Series Analysis</subject><subject>Intervention</subject><subject>Length of Stay</subject><subject>Medical Errors - prevention & control</subject><subject>Operating Rooms - organization & administration</subject><subject>Operating Rooms - standards</subject><subject>Orthopedic Procedures - methods</subject><subject>Orthopedic Procedures - standards</subject><subject>Patient Care Team - organization & administration</subject><subject>Patient Care Team - standards</subject><subject>Patient safety</subject><subject>Resource management</subject><subject>Studies</subject><subject>Teamwork</subject><subject>Theater</subject><subject>Time series</subject><subject>Training</subject><subject>Variance analysis</subject><issn>2044-5415</issn><issn>2044-5423</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkTtPBCEUhYnRqNH9ATZmEhsLR3kM87AzG1_JJjZaExjuKOsMrMBobP3lsg8trKTgXuA7B8hB6Ijgc0JYeaGG-VvIKSZFjjGjuNhC-2kucl5Qtv3bE76HJiHMcRqsaRrMdtEe5Zizmlb76Osqa92gjAWdRZDDh_OvWfTSWGOfM2l1ttoJMbXSaxNkNM5mxkbw72A3i8wtwKeTJIkvIKOHcJl8bfSu75PzCvfjIi5vMQNkAbyBkGxH_XmIdjrZB5hs6gF6url-nN7ls4fb--nVLFfp3TEHDbVqVFm1mPMO1y1wopWWvNRMMUJTrXVXVB2jUJRSll3La1C0wq0CxRk7QKdr34V3byOEKAYTWuh7acGNQZCyJCWllBX_QDllDcU1TejJH3TuRm_TRwSpqrpmFaZLQ7KmWu9C8NCJhTeD9J-CYLGMU6ziFMs4xTrOpDneOI9qAP2r-AkvAWdrIGn_4fcN6lWs0g</recordid><startdate>201502</startdate><enddate>201502</enddate><creator>Morgan, Lauren</creator><creator>Pickering, Sharon P</creator><creator>Hadi, Mohammed</creator><creator>Robertson, Eleanor</creator><creator>New, Steve</creator><creator>Griffin, Damian</creator><creator>Collins, Gary</creator><creator>Rivero-Arias, Oliver</creator><creator>Catchpole, Ken</creator><creator>McCulloch, Peter</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope></search><sort><creationdate>201502</creationdate><title>A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study</title><author>Morgan, Lauren ; Pickering, Sharon P ; Hadi, Mohammed ; Robertson, Eleanor ; New, Steve ; Griffin, Damian ; Collins, Gary ; Rivero-Arias, Oliver ; Catchpole, Ken ; McCulloch, Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b399t-ede8b9b67c055f08ce51dbda56d3b31256d8df47f32e46aa6fc58eb270cbeb533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aviation</topic><topic>Bias</topic><topic>Checklist - utilization</topic><topic>Clinical outcomes</topic><topic>Data collection</topic><topic>Education, Medical, Continuing</topic><topic>Health administration</topic><topic>Humans</topic><topic>Interrupted Time Series Analysis</topic><topic>Intervention</topic><topic>Length of Stay</topic><topic>Medical Errors - prevention & control</topic><topic>Operating Rooms - organization & administration</topic><topic>Operating Rooms - standards</topic><topic>Orthopedic Procedures - methods</topic><topic>Orthopedic Procedures - standards</topic><topic>Patient Care Team - organization & administration</topic><topic>Patient Care Team - standards</topic><topic>Patient safety</topic><topic>Resource management</topic><topic>Studies</topic><topic>Teamwork</topic><topic>Theater</topic><topic>Time series</topic><topic>Training</topic><topic>Variance analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morgan, Lauren</creatorcontrib><creatorcontrib>Pickering, Sharon P</creatorcontrib><creatorcontrib>Hadi, Mohammed</creatorcontrib><creatorcontrib>Robertson, Eleanor</creatorcontrib><creatorcontrib>New, Steve</creatorcontrib><creatorcontrib>Griffin, Damian</creatorcontrib><creatorcontrib>Collins, Gary</creatorcontrib><creatorcontrib>Rivero-Arias, Oliver</creatorcontrib><creatorcontrib>Catchpole, Ken</creatorcontrib><creatorcontrib>McCulloch, Peter</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><jtitle>BMJ quality & safety</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morgan, Lauren</au><au>Pickering, Sharon P</au><au>Hadi, Mohammed</au><au>Robertson, Eleanor</au><au>New, Steve</au><au>Griffin, Damian</au><au>Collins, Gary</au><au>Rivero-Arias, Oliver</au><au>Catchpole, Ken</au><au>McCulloch, Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study</atitle><jtitle>BMJ quality & safety</jtitle><addtitle>BMJ Qual Saf</addtitle><date>2015-02</date><risdate>2015</risdate><volume>24</volume><issue>2</issue><spage>111</spage><epage>119</epage><pages>111-119</pages><issn>2044-5415</issn><eissn>2044-5423</eissn><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 Design: Controlled interrupted time series with a 3 month intervention and observation phases before and after. Setting: Operating theatres conducting elective orthopaedic surgery in a single hospital system (UK Hospital Trust). Intervention: 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. Measures: 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. Discussion 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.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>25053827</pmid><doi>10.1136/bmjqs-2014-003204</doi><tpages>9</tpages></addata></record> |
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| subjects | Aviation Bias Checklist - utilization Clinical outcomes Data collection Education, Medical, Continuing Health administration Humans Interrupted Time Series Analysis Intervention Length of Stay Medical Errors - prevention & control Operating Rooms - organization & administration Operating Rooms - standards Orthopedic Procedures - methods Orthopedic Procedures - standards Patient Care Team - organization & administration Patient Care Team - standards Patient safety Resource management Studies Teamwork Theater Time series Training Variance analysis |
| title | A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study |
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