Patient safety risk factors in minimally invasive surgery: a validation study

This study was conducted to adapt and validate a patient safety (PS) framework for minimally invasive surgery (MIS) as a first step in understanding the clinical relevance of various PS risk factors in MIS. Eight patient safety risk factor domains were identified using frameworks from a systems approach to patient safety. A questionnaire was drafted containing 34 questions. Three experts in the field of patient safety critically reviewed the questionnaire on clinical relevance and completeness. The questionnaire was distributed among known patient safety experts in person and also sent electronically. A total of 41 questionnaires were distributed and the response rate was 71%. The intraclass correlation coefficient was 0.42 representing moderate agreement. For seven of nine risk domains, Cronbach's alpha was sufficient (α > 0.7). Mean scores of the risk domains showed the following order of influence on patient safety from high to low: surgeon's experience [6.6, standard deviation (SD) 0.5], technical skills surgeon (6.6, SD 0.7), technology (5.9, SD 1.1), complications (5.9, SD 1.2), social interaction (5.0, SD 1.0), leadership surgeon (5.4, SD 1.2), blood loss (5.0, SD 1.2), length of surgery (5.0, SD 1.3), surgical team (4.9, SD 1.3), fallibility (4.9, SD 1.3), patient (4.5, SD 1.5), safety measures (4.4, SD 1.5), and finally environment(3.9, SD 1.5). This study is an initiative to give insight into clinical relevance of the maze of PS risk factors in MIS. All investigated risk domains were considered to be of noticeable influence on PS. Nevertheless, it is possible to prioritize various risk domains. In fact, experience and technical skills of the surgeon, technology, and complications are rated as the most important risk factors, closely followed by social interaction and leadership of the surgeon. Patient, safety measures, and environment are rated as the least important risk factors.