The TEAM instrument for measuring emergency team performance: validation of the Swedish version at two emergency departments


Klas Karlgren1,2,3* , Anders Dahlström1,4, Anderz Birkestam5, Annelie Drevstam Norling5, Gustav Forss ,Andersson Franko6, Simon Cooper7, Thomas Leijon8 and Charlotta Paulsson8


Background: The Team Emergency Assessment Measure (TEAM) questionnaire is designed for rating the nontechnical performance of emergency medical teams during emergencies, e.g., resuscitation or trauma management.Originally developed in Australia it has today been translated and validated into eleven languages, but a Swedish version is lacking. The aim was therefore to cross-culturally translate and evaluate the reliability and validity of the TEAMquestionnaire in a Swedish health care setting.
Methods: The instrument was forward and backward translated and adapted into a Swedish context according
to established guidelines for cross-cultural adaptation of survey-based measures. The translated version was tested
through 78 pairwise assessments of 39 high-priority codes at the emergency departments of two major hospitals. The
raters observed the teams at work in real time and flled in the questionnaires immediately afterwards independently
of each other. Psychometric properties of the instrument were evaluated.
Results: The original instrument was translated by pairs of translators independently of each other and reviewed by
an expert committee of researchers, nurses and physicians from diferent specialties, a linguist and one of the original
developers of the tool. A few adaptations were needed for the Swedish context. A principal component factor analysis confrmed a single ‘teamwork’ construct in line with the original instrument. The Swedish version showed excellentreliability with a Cronbach’s alpha of 0.955 and a mean inter-item correlation of 0.691. The mean item-scale correlation of 0.82 indicated high internal consistency reliability. Inter-rater reliability was measured by intraclass correlationand was 0.74 for the global score indicating good reliability. Individual items ranged between 0.52 and 0.88. No foor efects but ceiling efects were noted. Finally, teams displaying clear closed-loop communication had higher TEAM scores than teams with less clear communication.
Conclusions: Real time observations of authentic, high priority cases at two emergency departments show that the
Swedish version of the TEAM instrument has good psychometric properties for evaluating team performance. The
TEAM instrument is thus a welcome tool for assessing non-technical skills of emergency medical teams.

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