Summary of findings for the main comparison. Interactive training for in‐hospital‐based healthcare providers on the management of life‐threatening emergencies: effects on clinical practice and patient outcomes.

The effects of interactive training of healthcare providers on the management of life‐threatening emergencies in hospital
Patient or population: Participants: Healthcare workers delivering life‐saving emergency care in a hospital setting (obstetric/labour and delivery staff, physicians, skilled birth attendants, midwives, midlevel surgical trainees, anaesthesiologists, nurses, internal medical residents) Population: Patients who suffer life‐threatening emergencies in hospital: women around the time of birth, neonates, trauma patients, and adults undergoing resuscitation Setting: All hospital settings are included. The evidence for this review is drawn from the Netherlands, Denmark, the USA, China, Pakistan, Kenya, Mexico, and Ghana. Intervention: Interactive training, i.e. any training including a component in which participants are not just passive recipients of the training Comparison: Standard training delivered at the facilities, no training, or an element of the intervention (e.g. a new training session) but only the didactic component
Outcomes (number of studies)	No. participants/no. in the population studied	Certainty of the evidence (GRADE)	Impact and selected results
Survival to hospital discharge (1 study)	30 participants 98 events (cardiac arrests) observed	⊕⊕⊝⊝ Low 1	Interactive emergency training strategies may make little or no difference in survival to hospital discharge.
Morbidity rate (3 studies)	1778 participants 57,193 in the population studied2	⊕⊝⊝⊝ Very low 3	It is uncertain whether interactive training leads to change in morbidity rates.
Protocol or guideline adherence (3 studies)	156 participants 558 in the population studied	⊕⊝⊝⊝ Very low 4	It is uncertain whether interactive training leads to change in protocol or guideline adherence.
Patient outcomes (5 studies)	951 participants 314,055 in the patient population	⊕⊝⊝⊝ Very low 5	It is uncertain whether interactive training leads to change in patient outcomes.
Clinical practice outcomes (4 studies)	1417 participants 28,676 in the population (patients and staff)2	⊕⊝⊝⊝ Very low 6	It is uncertain whether interactive training leads to changes in clinical practice outcomes.
Organisation of care (2 studies)	634 participants 179,400 in the patient population	⊕⊝⊝⊝ Very low 7	It is uncertain whether interactive training leads to change in organisation‐of‐care measures.
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

¹We downgraded the certainty of the evidence to low due to high risk of bias and imprecision.
 ²One study, Riley 2011, did not report numbers for participants or population.
 ³We downgraded the certainty of evidence to very low due to high risk of bias, inconsistency and imprecision.
 ⁴We downgraded the certainty of evidence to very low due to high risk of bias, inconsistency of findings and the small number of participants.
 ⁵We downgraded the certainty of evidence to very low due to high risk of bias, inconsistent results and small sample sizes.
 ⁶We downgraded the certainty of evidence to very low due to risk of bias, inconsistency in results and due the sample size being small or unclear in some studies.
 ⁷We downgraded the certainty of evidence to very low due to high risk of bias and inconsistency between studies.