Table 2.
Author | Setting | Research aim/question/hypothesis | Design | Intervention | Sample size | Outcome measures | Tools | Results |
---|---|---|---|---|---|---|---|---|
Bleakley et al., 2006 [34] |
OT |
Whether a sustained complex educational intervention would result in incremental, longitudinal improvement in attitudes and values towards interprofessional teamwork |
Quasi-experimental, pre-test and post- test measures (findings from round 2 of the intervention) |
Three strands: 1) data-driven iterative education in human factors; 2) establishment of a local, reactive ‘close call’ incident-reporting system; 3) team self-review (briefing and debriefing across all teams) |
All general, trauma, and orthopedic theaters within one teaching hospital and two small satellite units |
Teamwork climate |
Validated SAQ |
Intervention group had a higher aggregate teamwork climate score |
Bleakley et al., 2012 [35] |
OT |
Whether a sustained complex educational intervention would result in incremental, longitudinal improvement in attitudes and values towards interprofessional teamwork |
Pre-interventino and post-intervention (findings from round 3 of the intervention) |
Three strands: 1) data-driven iterative education in human factors; 2) establishment of a local, reactive ‘close call’ incident = reporting system ; 3) team self-review (briefing and debriefing across all teams |
All general, trauma, and orthopedic theaters within one UK teaching hospital and two small satellite units |
Teamwork climate |
Validated SAQ |
Mean ‘teamwork climate’ scores improved incrementally and significantly |
Brock et al., 2013 [40] |
Medical, nursing, pharmacy and physician assistant students at one university |
For students to acquire effective interprofessional team communication skills |
Pre-test/post-test |
Didactic instruction on patient safety and TeamSTEPPS communication skills. Students divided into IP teams for three simulated exercises and debriefing (observer/participant role) (4 hour training block) |
149 students completed pre-test and post-test assessments |
Attitudes towards team communication; attitude/knowledge/motivation/utility/SE towards IP skills; key communication behaviors; understanding; program evaluation |
Validated TeamSTEPPS TAQ, AMUSE, self-report/Likert scale |
Significant differences across all outcome measures |
Capella et al., 2010 [41] |
Level 1 trauma center |
Does trauma team training improve team behaviors in the trauma room? If so, does improved teamwork lead to more efficiency in the trauma room and improved clinical outcomes? |
Pre-training/post-training intervention design |
2 hour didactic instruction (roles, responsibilities, TeamSTEPPS essentials (that is, communication tools)) and simulation in a learning center/simulation laboratory |
33 trauma resuscitations pre-training, 40 post-training |
Assessment of team performance; clinical outcome and clinical timing data |
Validated TPOT |
Significant improvement in all teamwork domains. Significant improvements in some clinical timing/outcome measures |
Catchpole et al., 2010 [33] |
Surgery (maxillofacial, vascular and neurosurgery) |
The effects of aviation-style training on three surgical teams from different specialties |
Prospective study before and after an intervention |
1 to 2 days class-based series of interactive modules (including teamwork, communication, leadership, basic cognition, SA, decision-making, briefing, and debriefing) followed by team coaching (value of briefing/debriefing) |
112 operations (51 before and 61 after the intervention) |
Attitudes to safety and cultural context. Frequency of pre-list briefings, pre-incision time-outs/stop checks, post-case debriefing, and dimensions of team skills |
SAQ; structured observations and validated NOTECHS method to classify team skills |
Significantly more briefings, debriefings, and stop checks. No improvement in teamwork |
Mayer et al., 2011 [36] |
Pediatric and surgical ICU’s |
Implementation of TeamSTEPPS |
Pre-training/post-training intervention design |
Change team trained/coached front-line staff, comprising 2.5 hour training sessions and group training in practice (ad hoc rather than intact teams) |
12 attending physicians, 157 nurses, 90 respiratory therapists |
Staff interviews, observations of teamwork, clinical timing data, clinical infection data, perception of safety culture, strengths/weaknesses of the unit, job satisfaction |
TENTS, EOS, HSOPC, NDNQI |
Significant improvements in team performance/perception of teamwork (12 month follow-up). Significant decrease in clinical timing |
Miller et al., 2012 [37] |
Level 1 trauma center/ academic tertiary care center |
An ISTSP could be implemented in the ED and this would improve teamwork and communication in the clinical setting |
Pre-training/post-training intervention design involving all members of the trauma team |
Standardized lecture that specified roles, responsibilities, order of tasks, andposition in resuscitation area followed by simulation (ad hoc teams) |
39 real trauma activations observed |
Teamwork and communication |
Validated clinical teamwork scale |
Teamwork and communication improved, but effect not sustained after the program |
Nielson et al., 2007 [38] |
Obstetrics |
To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery |
Cluster randomized controlled trial |
Instructor training session: standardized teamwork training curriculum based on CRM, which emphasized communication and team structure. Instructor created ad hoc workplace teams |
1,307 personnel trained and 28,536 deliveries analyzed |
Adverse maternal/neonatal outcomes; clinical process measures |
Adverse outcome index |
Training had no significant effect |
Wallin et al., 2007 [43] |
Trauma |
To evaluate the outcome of a CRM target-focused instructional strategy on team behavior and attitude |
Prospective study |
Simulation |
15 medical students; observations of 8 trauma scenarios in simulation classroom |
Behavior performance, team attitude |
Structured observation schedule |
Improvement in observed team behavior. No attitude change |
Weaver et al., 2010 [44] |
OR |
Does TeamSTEPPS training meaningfully affect teamwork behavior in OR teams? Does this teamwork positively affect important outcomes such as patient safety culture? |
Mixed model design with one between-groups factor and two within-groups factors |
TeamSTEPPS training curricula, including a 4 hour didactic session (competency-based), including interactive role-playing activities |
Three surgeons and their teams |
Trainee reactions, trainee learning, behavior on the job, results (degree to which training affected safety/quality) |
Questionnaire survey; TeamSTEPPS learning benchmark test; CATS observation tool; HSOPS; ORMQ |
Positive results at all levels of evaluation |
Wolf et al., 2010 [42] |
OR |
MTT has been touted as a way to improve teamwork and patient safety in the OR |
Post-training data collection |
1 day didactic modules for all staff, with video and role-play. Topics included human factors, communication, fatigue recognition, briefing/debriefing training |
4,863 MTT debriefings analyzed |
Team functioning, case delays, case scores |
Debriefing/briefing checklist |
Case delays decreased and case scores increased; sustained at 24 months. Improved perception of patient safety and teamwork |
Wisborg et al., 2006 [39] | Trauma | To describe a team intervention and assess the feasibility of the intervention | Pre-training/post- training; intervention design | 3.5 hour didactic session (teamwork/cooperation/ communication skills) and practical training session for all trauma team members in practice using simulation and debriefing | 28 Norwegian hospitals and 2,860 trauma team members participated in the training | Evaluation of experience | Questionnaire | High perception of learning |
AMUSE, Attitude, Motivation, Teamwork, Self Efficacy; CRM, crew resource management; ED, emergency department; EOS, Employee Opinion Survey; HSOPC, Hospital Survey on Patient Safety Culture; ICU, Intensive Care Unit; IP, interprofessional; ISTS, In situ Trauma Simulation; MTT, medical team training; NDNQI, National Database of Nursing Quality Indicators; NOTECHS, no technical skills; OR, operating room; OT, operating theater; POT, Trauma Team Performance Observation Tool; SAQ, Safety Attitudes Questionnaire; SA, situational awareness; SE, self efficacy; TAQ, Teamwork Attitude Questionnaire; TeamSTEPPS, Team Strategies and Tools to Enhance Performance and Patient Safety; TENTS, Team Evaluation of Non-technical skills.