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To establish a cross-cultural adaptation of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey and to use this instrument to evaluate the impact of a safety intervention. Cross-cultural adaptation and before-and-after evaluation study. 5 ICU. Medical residents, attending physicians, and nurses at those ICU. Adaptation of the SCORE survey to Spanish culture. The adapted survey was used to assess all safety-culture-related domains before and one-year after implementing the use of a safety tool, Real-Time Ra