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The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery (UK)

International Literature

posted by WM Admin on 22 April 2015



In this study, the authors evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes in 3 operating theatres in a UK district general hospital (1 control group and 2 intervention groups).

A 1-day teamwork training course for all staff, followed by 6 weeks of weekly in-service coaching to embed learning. Seventy-two 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.

The authors 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). They 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. They recorded complications, re-admissions and duration of hospital stay using hospital administrative data. 

Mean 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.

The authors conclude that teamwork training was associated with improved non-technical skills in theatre teams but also with a rise in operative glitches.

This is an open access article and is available to read in free full text at:

Morgan, L., et al. (2015). The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: A controlled interrupted time series study. BMJ Open, 5:e006216.