A Proactive Risk Assessment Framework to Enhance Patient Safety in Operating Rooms

  • Maryam TabibzadehEmail author
  • Gelareh Jahangiri
Conference paper
Part of the Advances in Intelligent Systems and Computing book series (AISC, volume 590)


Patient safety, as a main aspect of quality of care, has been a major issue over the last decades in the healthcare industry. The number of preventable medical errors in hospitals has been noticeably high. These errors are more likely to occur in intensive care units including Operating Rooms (ORs). Moreover, preventable errors such as operating on a wrong body part have serious consequences. This paper fills an important gap by proposing a framework for proactive risk assessment of operations in ORs through the identification and monitoring of appropriate Leading Safety Indicators (LSIs) to evaluate the safety of operations and generate warning/predicting signals for potential failures. These LSIs are identified across the six layers of the Rasmussen’s Risk Management Framework, which each represents a main group of involved decision-makers. These layers in our context, from top to bottom, are: government; regulators; hospital; surgery division management; surgery personnel; and work processes.


Proactive risk assessment Patient safety Operating Rooms (ORs) Healthcare industry Leading Safety Indicators (LSIs) Wrong Site Surgery (WSS) Jens Rasmussen 



We would like to convey our extensive gratitude to Mr. Felipe Osorno, the Executive Administrator of the Value Improvement Office at the Keck Medicine of USC (University of Southern California), and Dr. Josh Hyatt, the Executive Director of the Office of Integrated Risk Management at the Keck Medicine of USC, for their advice and guidance. This work however, should not necessarily be construed as their representative positions or be endorsed by them.


  1. 1.
    IOM: To err is human: building a safer health system. In: Kohn, L.T., Corrigan, J.M., Donaldson, M.S. (eds.) Committee on Quality of Health Care in America. Institute of Medicine (IOM), The National Academies Press, Washington, DC (2000)Google Scholar
  2. 2.
    IOM: Crossing the Quality Chasm: A New Health System for the 21st Century. Committee on Quality of Health Care in America. Institute of Medicine (IOM), The National Academies Press, Washington, DC (2001)Google Scholar
  3. 3.
    Battles, J.B., Lilford, R.J.: Organizing patient safety research to identify risks and hazards. Qual. Saf. Healthc. 12, 112–117 (2003)CrossRefGoogle Scholar
  4. 4.
    Carayon, P., Hundt, A.S., Karsh, B.-T., Gurses, A.P., Alvarado, C.J., Smith, M., Brennan, F.P.: Work system design for patient safety: The SEIPS model. Qual. Saf. Healthc. 15(Suppl I), 50–58 (2006)CrossRefGoogle Scholar
  5. 5.
    Karnon, J., McIntosh, A., Dean, J., Bath, P.A., Hutchinson, A., Oakley, J., Thomas, N., Pratt, P., Freeman-Parry, L., Karsh, B.T., Gandhi, T., Tappenden, P.: A prospective hazard and improvement analytic approach to predicting the effectiveness of medication error interventions. Saf. Sci. 45(4), 523–539 (2007)CrossRefGoogle Scholar
  6. 6.
    Karsh, B.T., Holden, R.J., Alper, S.J., Or, C.K.: A human factors engineering paradigm for patient safety: designing to support the performance of the health care professional. Qual. Saf. Healthc. 15(Suppl I), 59–65 (2006)CrossRefGoogle Scholar
  7. 7.
    Slonim, A.D., Bish, E.K., Steighner, L.A., Zeng, X., Crossno, R.: Proactive risk assessment of surgical site infections in ambulatory surgery centers. Final report (Prepared by the American Institutes of Research under Contract No. 290-06-00019i-12). Agency for Healthcare Research and Quality (AHRQ) Publications No. 12-0045-EF, Rockville, MD (2012)Google Scholar
  8. 8.
    Rasmussen, J.: Risk management in a dynamic society: a modeling problem. Saf. Sci. 27(2), 183–213 (1997)MathSciNetCrossRefGoogle Scholar
  9. 9.
    Branford, K.: Seeing the big picture of mishaps: applying the AcciMap approach to analyze system accidents. Aviat. Psychol. Appl. Hum. Factors 1(1), 31–33 (2011)CrossRefGoogle Scholar
  10. 10.
    Rasmussen, J., Svedung, I.: Proactive Risk Management in a Dynamic Society, 1st edn. Raddningsverket, Risk and Environmental Department, Swedish Rescue Services Agency, Karlstad, Sweden (2000)Google Scholar
  11. 11.
    Keeney, R.L., Gregory, R.S.: Selecting attributes to measure the achievement of objectives. Oper. Res. 53(1), 1–11 (2005)CrossRefzbMATHGoogle Scholar
  12. 12.
    Osorno, F.: Personal communication. Executive Administrator, Value Improvement Office, Keck Medicine of USC, University of Southern California, 7 December 2016Google Scholar
  13. 13.
    Hyatt, J.: Personal Communication. Executive Director, Office of Integrated Risk Management, Keck Medicine of USC, University of Southern California, 20 December 2016Google Scholar
  14. 14.
    Feil, M.: Distraction in operating rooms. Pa. Patient Saf. Advis. 11(2), 45–52 (2014)Google Scholar
  15. 15.
    Agency for Healthcare Research and Quality (AHRQ): Wrong-Site, Wrong-Procedure and Wrong-Patient Surgery (2016). Accessed, 8 Oct 2016
  16. 16.
    Faltz, L.L., Morley, J.N., Flink, E., Dameron, P.D.: The New York Model: root cause analysis driving patient safety initiative to ensure correct surgical and invasive procedures. In: Henriksen, K., Battles, J.B., Keyes, M.A., Grady, M.L. (eds.) Advances in Patient Safety: New Directions and Alternative Approaches, vol. 1. Assessment. Agency for Healthcare Research and Quality (AHRQ) Publication No. 08-0034-1, Rockville, MD (2008)Google Scholar
  17. 17.
    Stahel, F.P., Mehler, S.P., Clarke, J.T., Varnell, J.: The 5th anniversary of the “Universal Protocol”: pitfalls and pearls revisited. Patient Saf. Surg. 3, 14 (2009)CrossRefGoogle Scholar
  18. 18.
    Morrison, W.K.: Select leading indicators to help measure safety. Safety+Health, The Official Magazine of the National Safety Council (NSC) Congress and Expo, 1 Feb 2014Google Scholar
  19. 19.
    Tabibzadeh, M., Meshkati, N.: Applying the AcciMap methodology to investigate a major accident on offshore drilling: a systematic risk management framework for oil and gas company. Society of Petroleum Engineers (SPE) Western Regional Meeting, SPE-174020-MS, Garden Grove, California, 27–30 April 2015Google Scholar
  20. 20.
    Wormnaes, M.: Leading indicators for real time monitoring of risk in healthcare organizations. Master’s thesis, University of Stavanger, Stavanger, Norway (2015)Google Scholar
  21. 21.
    American Petroleum Institute (API): Process safety performance indicators for the refining and petrochemical industries. API Recommended Practice 754, Washington, D.C. (2010)Google Scholar
  22. 22.
    Chemical Safety and Hazard Investigation Board (CSB): Chevron Richmond Refinery Pipe Rupture and Fire at #4 Crude Unit. Report No. 2012-03-I-CA, Washington, DC. CSB (2015)Google Scholar
  23. 23.
    Rassweiler, C.M., Mamoulakis, C., Kenngott, G.H., Rassweiler, J., Rosette, D.J., Laguna, P.M.: Classification and detection of errors in minimally invasive surgeries. J. Endourol. 25(11), 1713–1721 (2011)CrossRefGoogle Scholar
  24. 24.
    International Association of Oil and Gas Producers (OGP): Process safety recommended practice on key performance indicators. Report No. 456 (2011)Google Scholar
  25. 25.
    Center for Chemical Process Safety (CCPS): Process Safety Leading and Lagging Metrics. CCPS of the American Institute of Chemical Engineers (AIChE), New York, NY. CCPS, January 2011Google Scholar
  26. 26.
    van Beuzekom, M., Boer, F., Akerboom, S., Hudson, P.: Patient safety in the operating room: an intervention study on latent risk factors. BMC Surg. 12(1), 1 (2012)CrossRefGoogle Scholar
  27. 27.
    Matern, U., Koneczny, S.: Safety, hazards and ergonomics in the operating room. Surg. Endosc. 21(11), 1965–1969 (2007)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Manufacturing Systems Engineering and ManagementCalifornia State University, NorthridgeNorthridgeUSA

Personalised recommendations