ORIGINAL SCIENTIFIC REPORTS Observational Teamwork Assessment for Surgery (OTAS): Refinement and Application in Urological Surgery Shabnam Undre Æ Nick Sevdalis Æ Andrew N. Healey Æ Sir Ara Darzi Æ Charles A. Vincent Published online: 9 May 2007 Ó Socie´te´ Internationale de Chirurgie 2007 Abstract Background Teamwork in surgical teams is at the fore- front of good practice guidelines and empirical research as an important aspect of safe surgery. We have developed a comprehensive assessment for teamwork in surgery—the Observational Teamwork Assessment for Surgery (OTA- S)—and we have tested it for general surgical procedures. The aim of the research reported here was to extend the assessment to urology procedures. Methods After refining the original assessment, we used it to observe 50 urology procedures. The OTAS comprises a procedural task checklist that assesses patient, equipment/ provisions, and communication tasks as well as ratings on five team behavior constructs (communication, coopera- tion, coordination, leadership, and monitoring). Teamwork was assessed separately in the surgical, anesthesia, and nursing subteams in the operating theater. We also assessed the reliability of the behavioral scoring. Results Regarding task completion, a number of com- munication and equipment/provisions tasks were not rou- tinely performed during the operations we observed. Regarding teamwork-related behaviors, adequate reliability was obtained in the scoring of behaviors. Anesthetists and nurses obtained their lowest scores on communication. Surgeons’ scores revealed a more complex pattern. In addition to low scores on communication, surgeons’ teamwork behaviors appeared to deteriorate as the proce- dures were finishing. Conclusions Our findings suggest that OTAS is applicable to various branches of surgery. Separate assessment of the subteams in the operating theater provides useful informa- tion that can be used to build targeted teamwork training aiming to improve surgical patients’ safety and outcomes. In recent years, there have been major changes in the way surgical outcomes are understood and analyzed. Tradition- ally, surgical outcomes have been perceived as a function of the operating surgeon’s skill: the more skilled the surgeon, the better the postoperative outcome for the patient. Recent empirical and conceptual work on the assessment of surgical skills suggests that the surgeon’s manual and perceptual dexterity (i.e., the main components of skill in the traditional view) may not be the only factor mediating the relation be- tween patient risk factors and postoperative outcomes [1, 2]. Features of the operative environment [3], the quality of the communication among operating theater professionals [4– 7], and the quality of the teamwork of the operating theater team determine, jointly with the surgeon’s technical dex- terity, postoperative outcomes. Teamwork between clinicians appears to be at the forefront of the relevant good-practice guidelines and empirical research. The Institute of Medicine has recom- mended team training to improve teamwork [8]. Teamwork and attitudes toward it have been investigated in a number of specialist clinical domains, such as neonatal and peri- natal care [9, 10], accident and emergency departments [11, 12], and critical care medicine [13]. In relation to operating theaters, recent studies suggest that different S. Undre (&) Á N. Sevdalis Á A. N. Healey Á C. A. Vincent Clinical Safety Research Unit, Department of Bio-Surgery and Surgical Technology, Imperial College, 10th Floor, QEQM Building, St. Mary’s Hospital, London W2 1NY, UK e-mail: s.undre@imperial.ac.uk N. Sevdalis National Patient Safety Agency, London, UK Sir A. Darzi Department of Bio-Surgery and Surgical Technology, Imperial College, London, UK 123 World J Surg (2007) 31:1373–1381 DOI 10.1007/s00268-007-9053-z