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A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study.
Morgan, Lauren; Pickering, Sharon P; Hadi, Mohammed; Robertson, Eleanor; New, Steve; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter.
Afiliación
  • Morgan L; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
  • Pickering SP; Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
  • Hadi M; Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
  • Robertson E; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
  • New S; Saïd Business School, University of Oxford, Oxford, UK.
  • Griffin D; Warwick Medical School, University of Coventry and Warwick, Warwick, UK.
  • Collins G; Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
  • Rivero-Arias O; Nuffield Department of Population Health, University of Oxford, Oxford, UK Red de Investigación de Servicios Sanitarios en Cronicidad (REDISSEC), Spain.
  • Catchpole K; Cedars-Sinai Medical Centre, Los Angeles, USA.
  • McCulloch P; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
BMJ Qual Saf ; 24(2): 111-9, 2015 Feb.
Article en En | MEDLINE | ID: mdl-25053827
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. 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.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Quirófanos / Grupo de Atención al Paciente Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: BMJ Qual Saf Año: 2015 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Quirófanos / Grupo de Atención al Paciente Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: BMJ Qual Saf Año: 2015 Tipo del documento: Article