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Duclos A, Peix JL, Piriou V, Occelli P, Denis A, Bourdy S, Carty MJ, Gawande AA, Debouck F, Vacca C, Lifante JC, Colin C, Aegerter P, Aouifi A, Arickx D, Aubart F, Baudrin D, Berry WR, Beuvry C, Bonnet F, Bouveret L, Cabarrot P, Cames E, Carty MJ, Caton J, Chenitz MC, Clergues F, Colin C, Coudray JM, Damiens M, Dauzac C, Debono B, Debouck F, De Germay B, Deleforterie AC, Denis A, Desrousseaux JF, Didelot MP, Doat B, Domingo-Saidji NY, Duclos A, Durieux P, Fessy M, Hardy P, Cariven P, Fontas N, Ganansia P, Gawande AA, Giraud F, Gostiaux G, Habi S, Haga S, Houlgatte A, Jaffe M, Jourdan J, Kaczmarek N, Lamblin S, Level C, Liaras E, Lifante JC, Lipsitz SR, Majchrzak C, Malavaud B, Serres TM, Martin X, Martinet C, Maupetit B, Michel P, Movondo A, Naamani B, Nacry R, Occelli P, Olousouzian S, Papin P, Paquet JC, Parfaite A, Pattou F, Paugam C, Pavy E, Peix JL, Petit H, Pierre S, Piriou V, Poupon Bourdy S, Pradere B, Quesne M, Radola Y, Raould A, Rongieras F, Rouquette I, Sanders V, Sanz F, Sens F, Surmont S, Sicre C, Tabur D, Targosz P, Thery D, Toppan N, Usandizaga G, Vacca C, Verheyde I, Zadegan F. Cluster randomized trial to evaluate the impact of team training on surgical outcomes. Br J Surg 2016; 103:1804-1814. [DOI: 10.1002/bjs.10295] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/07/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The 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.
Methods
A 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.
Results
Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.
Conclusion
Surgical 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).
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Affiliation(s)
- A Duclos
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - J L Peix
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - V Piriou
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service d'Anesthésie Réanimation Médicale et Chirurgicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - P Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | - A Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - S Bourdy
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - M J Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - A A Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
- Ariadne Labs and Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - F Debouck
- Air France Consulting, AFM42, Chambourcy, France
| | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes, Lyon, France
| | - J C Lifante
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - C Colin
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | | | | | | | | | - D Baudrin
- Agence Régional de Santé de Toulouse
| | | | | | - F Bonnet
- Assistance Publique-Hôpitaux de Paris
| | | | | | - E Cames
- Centre Hospitalier Universitaire de Toulouse
| | - M J Carty
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Caton
- Clinique Emile Vialar de Lyon
| | | | | | | | | | | | - C Dauzac
- Assistance Publique-Hôpitaux de Paris
| | - B Debono
- Clinique des Cèdres de Cornebarrieu
| | | | | | | | | | | | | | | | | | | | - P Durieux
- Assistance Publique-Hôpitaux de Paris
| | | | - P Hardy
- Assistance Publique-Hôpitaux de Paris
| | | | - N Fontas
- Centre Hospitalier Universitaire de Toulouse
| | | | - A A Gawande
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - S Habi
- Centre Hospitalier de Vienne
| | - S Haga
- Infirmerie Protestante de Lyon
| | - A Houlgatte
- Hôpital d'Instruction des Armées du Val de Grâce
| | - M Jaffe
- Clinique Ambroise Paré de Toulouse
| | | | | | | | - C Level
- Assistance Publique-Hôpitaux de Paris
| | - E Liaras
- Hôpital Privé de Natécia de Lyon
| | | | - S R Lipsitz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - B Malavaud
- Centre Hospitalier Régional Universitaire de Toulouse
| | | | | | | | | | | | | | | | | | | | | | - P Papin
- Centre Hospitalier de Villefranche sur Saône
| | | | | | - F Pattou
- Centre Hospitalier Régional Universitaire de Lille
| | - C Paugam
- Assistance Publique-Hôpitaux de Paris
| | - E Pavy
- Hôpital Simone Veil d'Eaubonne
| | | | | | - S Pierre
- Institut Claudius Régaud de Toulouse
| | | | | | - B Pradere
- Centre Hospitalier Régional Universitaire de Lille
| | | | - Y Radola
- Centre Hospitalier Régional Universitaire de Lille
| | - A Raould
- Assistance Publique-Hôpitaux de Paris
| | - F Rongieras
- Hôpital d'Instruction des Armées Desgenettes de Lyon
| | | | - V Sanders
- Centre Hospitalier Régional Universitaire de Lille
| | - F Sanz
- Centre Hospitalier Régional Universitaire de Lille
| | | | | | | | | | | | - D Thery
- Institut Catholique de Lille
| | - N Toppan
- Clinique de l'Union de Saint Jean
| | | | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes de Lyon
| | | | - F Zadegan
- Assistance Publique-Hôpitaux de Paris
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