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Results The use of the SW-CRT is rapidly increasing and that areas of use are diverse. We illustrate how the design is being used to evaluate the effectiveness of a complex intervention, being rolled-out across 90 UK hospitals, to reduce mortality in patients undergoing emergency laparotomy. Quality of reporting is found to be low. In a SW-CRT more clusters are exposed to the intervention towards the end of the study than in its early stages. A result which prima facia might look to be suggestive of an effect of the intervention may therefore transpire to be the result of a positive underlying temporal trend. A large number of studies do not report how they allowed for temporal trends in the design or analysis.

The stepped wedge cluster randomised trial: an opportunity to increase the quality of evaluations of service delivery and public policy interventions