Department of Surgery and Cancer, Imperial College London, UK.
J Am Coll Surg. 2011 Feb;212(2):234-243.e1-5. doi: 10.1016/j.jamcollsurg.2010.11.001.
Effective teamwork is crucial for safe surgery. Failures in nontechnical and teamwork skills are frequently implicated in adverse events. The Observational Teamwork Assessment for Surgery (OTAS) tool assesses teamwork of the entire team in the operating room. Empirical testing of OTAS has yet to explore the content validity of the tool.
This was a cross-sectional observational study. Data were collected in 30 procedures by 2 trained researchers. Five teamwork behaviors were scored (ie, communication, leadership, cooperation, coordination, and monitoring) and behavior exemplar completion was recorded (phase 1). Expert operating room personnel (5 surgeons, 5 anesthesiologists, and 5 scrub nurses) assessed the content validity of the OTAS exemplar behaviors. Finally, a panel of operating room patient-safety experts refined the exemplars (phase 2).
In total, the observability (presence/absence) of 130 exemplars was assessed by 2 blinded observers in 30 general surgical cases. Observer agreement was high (Cohen's κ ≥ 0.41) for 83.85% (109 of 130) of exemplar behaviors; 60.77% (79 of 130) of exemplar behaviors were observed frequently with high observer agreement. The majority of the exemplars were rated by expert operating room practitioners and an expert panel as substantial contributors to teamwork and patient safety. Based on expert consensus, 21 behavior exemplars were removed from OTAS and an additional 23 were modified.
The exemplars of OTAS demonstrated very good content validity. Taken together with recent evidence on the construct validity of the tool, these findings demonstrate that OTAS is psychometrically robust for capturing teamwork in the operating room.
有效的团队合作对于手术安全至关重要。非技术和团队合作技能的失败经常与不良事件有关。手术观察性团队评估（OTAS）工具评估手术室中整个团队的团队合作。OTAS 的实证测试尚未探索工具的内容效度。
这是一项横断面观察性研究。数据由 2 名经过培训的研究人员在 30 例手术中收集。对 5 种团队合作行为进行评分（即沟通、领导、合作、协调和监控），并记录行为范例的完成情况（第 1 阶段）。手术室专家（5 名外科医生、5 名麻醉师和 5 名刷手护士）评估 OTAS 范例行为的内容效度。最后，手术室患者安全专家小组对范例进行了改进（第 2 阶段）。
在总共 30 例普通外科手术中，2 名盲法观察者评估了 130 个范例的可观察性（存在/不存在）。观察者之间的一致性很高（Cohen's κ≥0.41），对于 83.85%（130 个中的 109 个）的范例行为；60.77%（130 个中的 79 个）的范例行为观察到的频率很高，观察者之间的一致性也很高。大多数范例都被手术室执业医师和专家小组认为对团队合作和患者安全有重大贡献。根据专家共识，OTAS 从 21 个行为范例中删除，并修改了另外 23 个。
OTAS 的范例表现出很好的内容效度。结合该工具的结构效度的最新证据，这些发现表明 OTAS 在捕捉手术室中的团队合作方面具有良好的心理测量学特性。
