Cluster randomized trial to evaluate the impact of team training on surgical outcomes

BackgroundThe 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. MethodsA 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. ResultsSome 22779 patients were enrolled, including 5934 before and 16845 after team training implementation. The risk of major adverse events fell from 88 to 55 per cent in 16 intervention hospitals (adjusted odds ratio 057, 95 per cent c.i. 048 to 068; P<0001) and from 79 to 54 per cent in 15 control hospitals (odds ratio 064, 050 to 081; P<0001), resulting in the absence of difference between arms (ROR 090, 95 per cent c.i. 067 to 121; P=0474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals. ConclusionSurgical 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).