Table 2

Studies examining team-training effects on clinical process or patient outcomes

Study characteristics
CurriculumSettingDesignClinical processes or patient outcomes
Andreatta 201141OBEMANOBDescriptive
  • Five types of incongruent hospital policies or procedures governing clinical practice identified

Armour 201142TSORTime series
  • Significant reduction in surgical morbidity (20.2% vs 11%*) and mortality (2.7% vs 1%*)

  • Significant improvement in 4 of 6 SQIP measures*

  • Room turnover time decreased significantly (43 vs 35.5 min*), percentage of on-time first case starts improved (69% to 81%+)

  • Patient willingness to recommend significantly improved (77% to 89.3%*)

  • Evidence of some decay over 1 year post-training follow-up for mortality, morbidity, on-time starts and patient satisfaction, while SQIP remained improved

Carney 201169VA MTTORPre-post
Castner 201285TSMultipleNCGPT
Cooper 201153Leadership TTHospital managementPost only
Deering 201139TSCombat support hospitalPre-post
  • Decreased number of adverse events (22.2 vs 18.2 events+)

  • 83% decrease in medication and transfusion errors (7.1 vs 1.2*), 70% decrease in needlestick injury and exposures (4.0 vs 1.2*), 65% decrease communication incidents (5.2 vs 1.8*)

  • No significant decrease in incidents related to three other teamwork competencies

Figueroa 201265TSICUTime series
Fransen 201243MultidisciplinaryOBCluster RCT
  • Trained teams adhered to predefined obstetric procedures more frequently than non-trained teams (83% vs 46%*)

Frengley 201186CRMICUNCGPPT
  • Regardless of modality that clinical management skills were also taught, all participating teams improved clinical management scores*

Heard 201187CRMEndoscopyTime series
Kirschbaum 201288MultidisciplinaryORPre-post
Maxson 201189TSSurgeryTime series
Mayer 201135TSPICU
Longitudinal with non-equivalent control
  • Nosocomial infections decreased slightly+

  • Average time for placing patients on extracorporeal membrane oxygenation (ECMO) decreased (23 vs 14 min*)

  • No significant change in length of rapid response team events

McLaughlin 201144Trauma TTTraumaPost-only
Neily 201138VA MTTORRCC
  • 50% greater reduction in risk-adjusted surgical mortality for MTT group versus control (RR=1.49)*

  • Reduction of 0.5 deaths per 1000 procedures associated with every quarter that teamwork intervention was in place*

  • Qualitative interviews suggested improvements in overall perioperative efficiency, reduced length of procedures, improved first case on-time start times and equipment use

Patterson 2013 (online 2012)66Multidisciplinary TTPaediatric EDTime series
  • Patient safety event rate decreased (2–3 annually vs 1000 days since safety event, 12 m post)

Phipps 201270CRML&DPre-post
  • Decrease in adverse outcome index (AOI) (0.052 pre vs 0.043 post)

  • No significant change in patient satisfaction

Riley 201136TSL&DNCGPPT
  • Weighted adverse outcome score (WAOS)—an index of perinatal harm—decreased 37% for full intervention group only (1.15 pre vs 0.72 post*)

  • Variability in WAOS scores was decreased post-training for full intervention group only

Singer 201154Leadership TTHospital mgmt.Qual. Longitudinal
Steinemann 201190CRMTraumaProspective cohort
  • 16% reduction in ED resuscitation time*, 76% increase in completeness of clinical tasks*

  • No significant changes in mean hospital length of stay, ICU days or deaths

Stevens 201271CRMCardiac surgeryPre-post
Stocker 201291CRMPICUTime series
Tapson 201180CRMSurgeryLongitudinal
  • Significantly more post-training than pretraining charts met guideline recommendations and standards of care for timing, inpatient duration and prophylaxis use beyond discharge*

van Schaik 201192CRMPICUCross-sectional
Volk 201193CRMORPost-only
Young-Xu 201158VA MTTORRCC
  • 20% greater reduction in risk-adjusted surgical morbidity in the MTT group versus control (RR=1.20)*

  • +, improvement, but not statistically significant; CBT, case based learning; CRM, Crew or Crisis Resource Management; L&D, labor and delivery; NCGPT, non-equivalent comparison group post-test only; NCGPPT, non-equivalent comparison groups pre-test/post-test; OB, obstetrics; OBEMAN, obstetrics, emergency medicine, anesthesiology, and neonatology program; OR, operating room; Peds, pediatrics; PICU, pediatric intensive care unit; RCC, retrospective controlled cohort study; SBT, simulation based training; SICU, surgical intensive care unit; TS, TeamSTEPPS; VA MTT, VA Medical Team Training. *p<0.05.