Table 2 Evaluative studies

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