CONTINUING MEDICAL EDUCATION FORMATION MÉDICALE CONTINUE CAGS AND ACS EVIDENCE BASED REVIEWS IN SURGERY. 44 Is there an association between implementation of a medical team training program and surgical mortality?

Objective: To determine whether an association existed between the Veterans Health Administration (VHA) medical team training and surgical outcomes. Study design: Retrospective cohort study. Setting: 108 VHA hospitals (74 with and 34 without team training). Intervention: Medical team training consisted of a 1-day session with nurses, surgeons and anesthesiologists in attendance, followed by 4 quarterly structured telephone interviews. Data sources: VHA Surgical Quality Improvement Program (VASQIP), which included 182 409 patients between 2006 and 2008. Main outcome measure: Postoperative mortality. Results: The 74 facilities in the training program experienced an 18% reduction in annual mortality (rate ratio [RR] 0.82, 95% confidence interval [CI] 0.76– 0.91, p = 0.01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR 0.93, 95% CI 0.80–1.06, p = 0.59). Risk-adjusted mortality at baseline was 17 per 1000 procedures per year for the trained and 15 per 1000 per year for the nontrained facil ities. At the end of the study, the rates were 14 per 1000 per year for both groups. Propensity matching of the trained and nontrained groups demonstrated that the decline in risk-adjusted surgical mortality was about 50% greater in the trained (RR 1.49, 95% CI 1.10–2.07, p = 0.01) than in the nontrained group. A dose–response relationship for additional quarters of the training program was also demonstrated: for every quarter of the training program a reduction of 0.5 deaths per 1000 procedures occurred (95% CI 0.2–1.0, p = 0.001). Conclusion: Participation in the VHA Medical Team Training program was associated with lower surgical mortality.