Translation, cultural adaptation and content re-validation of the observational teamwork assessment for surgery tool

Background. Poor teamwork and nontechnical skill performance are increasingly recognized as important contributing factors to errors and adverse events in the operating room. Assessment of these safety critical skills is important to facilitate improvement, however there are no tools available to assess these safety skills in Latin America. This study aimed to translate, culturally adapt and content validate the Observational Teamwork Assessment for Surgery (OTAS) tool for use in Latin America. Methods. A multi-phase, multi-method study was conducted: Phase 1: translation and back-translation; Phase 2: content validity assessed via expert consensus; Phase 3: inter-rater reliability assessed via real-time observation in 98 general surgical procedures using OTAS-S. Results. The first change in OTAS-S, was to distinguish between the surgical nurses and scrub technicians (both OR team members are captured in the nursing sub-team in the original OTAS). OTAS-S consists of 168 exemplar behaviors: 60/114 identical to the exemplars listed in the original OTAS tool, 48/114 original exemplars underwent minor modifications, 13 were duplicated (to account for the additional sub-team distinguished in OTAS-S), 6 original exemplars were removed, and 47 new exemplar behaviors were added. Inter-observer agreement was substantial (KW = 0.602; IC: 0.581-0.620). The calculated KW by phase, behaviors and teams were between 0.534 and 0.678. Conclusions. The study provides a content validated teamwork assessment tool for use within Colombian operating rooms and potentially Latin-American. OTAS-S can be used to assess the quality of teamwork in ORs, facilitate structured debriefing and thus improve patient safety and reduce team-related errors.