Assessing system failures in operating rooms and intensive care units

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The current awareness of the potential safety risks in healthcare environments has led to the development of largely reactive methods of systems analysis. Proactive methods are able to objectively detect structural shortcomings before mishaps and have been widely used in other high-risk industries.


The Leiden Operating Theatre and Intensive Care Safety (LOTICS) scale was developed and evaluated with respect to factor structure and reliability of the scales. The survey was administered to the staff of operating rooms at two university hospitals, and intensive care units (ICUs) of one university hospital and one teaching hospital. The response rate varied between 40–47%. Data of 330 questionnaires were analysed. Safety aspects between the different groups were compared.


Factor analyses and tests for reliability resulted in nine subscales. To these scales another two were added making a total of 11. The reliability of the scales varied from 0.75 to 0.88. The results clearly showed differences between units (OR1, OR2, ICU1, ICU2) and staff.


The results seem to justify the conclusion that the LOTICS scale can be used in both the operating room and ICU to gain insight into the system failures, in a relatively quick and reliable manner. Furthermore the LOTICS scale can be used to compare organisations to each other, monitor changes in patient safety, as well as monitor the effectiveness of the changes made to improve the level of patient safety.

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