Effects of a national team training intervention for operating theatre teams on patient and staff outcomes: a stepped-wedge cluster-randomised trial and mixed-methods study.

Abstract

We evaluated a national, multidisciplinary in situ simulation-based team training intervention in New Zealand public hospitals. We hypothesised that outcomes for surgical patients and staff perceptions of teamwork and observed teamwork behaviours would improve after the intervention. In a stepped-wedge cluster trial, all New Zealand's 20 District Health Boards were semi-randomised into four cohorts. Training was progressively implemented with one cohort per year. Patient outcomes were derived from a national administrative dataset. Outcome measures were intervention uptake, days alive and out of hospital at 90 days (DAOH₉₀), pre-post staff Teamwork Perceptions Survey scores, and pre-post measures of observed teamwork performance during administration of the World Health Organisation Surgical Safety Checklist. Nineteen District Health Boards implemented training, and 41% of the estimated 3800 eligible staff participated. Post-intervention, DAOH₉₀ increased 0.12 days (n=436 785 surgical cases) but we could not separate the intervention's effect from other temporal factors. Teamwork Perceptions Survey scores improved by 0.35 (95% confidence interval, 0.10-0.59) (P=0.006), 0.37 (0.12-0.63) (P=0.006), and 0.50 (0.22-0.78) (P<0.001) on a 5-point scale for 'Overall', 'Communication and Shared Mental Model', and 'Trust and Accountability', respectively. There was no important effect on observed teamwork. We achieved small improvements in teamwork by involving 41% of New Zealand operating theatre staff in team training. Improved patient outcomes could not be solely attributed to our intervention, potentially reflecting high baseline levels of teamwork and surgical outcomes, diluting effects of the progressive uptake of the team training over intervention periods, and other confounders including the COVID-19 pandemic. ACTRN12617000017325.