Assessing and improving safety climate in a large cohort of intensive care units*

Sexton, J. Bryan; Berenholtz, Sean M.; Goeschel, Christine A.; Watson, Sam R.; Holzmueller, Christine G.; Thompson, David A.; Hyzy, Robert C.; Marsteller, Jill A.; Schumacher, Kathy; Pronovost, Peter J.

doi:10.1097/ccm.0b013e318206d26c

Cited by 172 publications

(73 citation statements)

References 36 publications

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“…Previous studies on the impact of safety climate on safety outcome have focused on either the effect of team training on perceived safety climate,34, 35 or assessed patient outcome 36. Implementation of CRM resulted in a culture change and a safer environment, illustrated by a decrease in malpractice expenses 37.…”

Section: Discussionmentioning

confidence: 99%

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Haerkens

Kox

Lemson

et al. 2015

Acta Anaesthesiol Scand

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BackgroundHuman factors account for the majority of adverse events in both aviation and medicine. Human factors awareness training entitled “Crew Resource Management (CRM)” is associated with improved aviation safety. We determined whether implementation of CRM impacts outcome in critically ill patients.MethodsWe performed a prospective 3‐year cohort study in a 32‐bed ICU, admitting 2500–3000 patients yearly. At the end of the baseline year, all personnel received CRM training, followed by 1 year of implementation. The third year was defined as the clinical effect year. All 7271 patients admitted to the ICU in the study period were included.The primary outcome measure was ICU complication rate. Secondary outcome measures were ICU and hospital length of stay, and standardized mortality ratio.ResultsOccurrence of serious complications was 67.1/1000 patients and 66.4/1000 patients during the baseline and implementation year respectively, decreasing to 50.9/1000 patients in the post‐implementation year (P = 0.03). Adjusted odds ratios for occurrence of complications were 0.92 (95% CI 0.71‐1.19, P = 0.52) and 0.66 (95% CI 0.51‐0.87, P = 0.003) in the implementation and post‐implementation year. The incidence of cardiac arrests was 9.2/1000 patients and 8.3/1000 patients during the baseline and implementation year, decreasing to 3.5/1000 patients (P = 0.04) in the post‐implementation year, while cardiopulmonary resuscitation success rate increased from 19% to 55% and 67% (P = 0.02). Standardized mortality ratio decreased from 0.72 (95% CI 0.63‐0.81) in the baseline year to 0.60 (95% CI 0.53‐0.67) in the post‐implementation year (P = 0.04).ConclusionOur data indicate an association between CRM implementation and reduction in serious complications and lower mortality in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Haerkens

Kox

Lemson

et al. 2015

Acta Anaesthesiol Scand

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“…However, despite HSOPS and related safety culture surveys [15][16][17] becoming common tools to assess safety culture in large collaboratives, the extent to which measures from these survey tools are associated with changes in catheter-associated infection rates is unclear. 8 18 Furthermore, although as outlined above, safety culture is strongly hypothesised to be very important to reduce hospital-acquired complications such as catheter-associated infections, it remains unclear how important changing safety culture is in reducing catheter-associated infections compared with the importance of standardising technical components of care such as standardising procedures.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives

et al. 2016

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BackgroundThe Agency for Healthcare Research and Quality (AHRQ) has funded national collaboratives using the Comprehensive Unit-based Safety Program to reduce rates of two catheter-associated infections—central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI), using evidence-based intervention bundles to improve technical aspects of care and socioadaptive approaches to foster a culture of safety.ObjectiveExamine the association between hospital units' results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates.MethodsWe analysed data from two prospective cohort studies from acute-care intensive care units (ICUs) and non-ICUs participating in the AHRQ CLABSI and CAUTI collaboratives. National Healthcare Safety Network catheter-associated infections per 1000 catheter-days were collected at baseline and quarterly postimplementation. The HSOPS was collected at baseline and again 1 year later. Infection rates were modelled using multilevel negative binomial models as a function of HSOPS components over time, adjusted for hospital-level characteristics.Results1821 units from 1079 hospitals (CLABSI) and 1576 units from 949 hospitals (CAUTI) were included. Among responding units, infection rates declined over the project periods (by 47% for CLABSI, by 23% for CAUTI, unadjusted). No significant associations were found between CLABSI or CAUTI rates and HSOPS measures at baseline or over time.ConclusionsWe found no association between results of the HSOPS and catheter-associated infection rates when measured at baseline and postintervention in two successful large national collaboratives focused on prevention of CLABSI and CAUTI. These results suggest that it may be possible to improve CLABSI and CAUTI rates without making significant changes in safety culture, particularly as measured by instruments like HSOPS.

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“…As noted, the PSC literature has largely taken this consensus approach. [6][7][8][9][10] In dispersion models, on the other hand, variability among individuals is the focal construct. Variability refers to the degree of disagreement among members regarding their unit's safety orientation.…”

Section: Introductionmentioning

confidence: 99%

Patient safety climate strength: a concept that requires more attention

Ginsburg

Oore²

2015

BMJ Qual Saf

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BackgroundWhen patient safety climate (PSC) surveys are used in healthcare, reporting typically focuses on PSC level (mean or per cent positive scores). This paper explores how an additional focus on PSC strength can enhance the utility of PSC survey data.Setting and participants442 care providers from 24 emergency departments (EDs) across Canada.MethodsWe use anonymised data from the Can-PSCS PSC instrument collected in 2011 as part of the Qmentum accreditation programme. We examine differences in climate strength across EDs using the Rwg(j) and intraclass correlation coefficients measures of inter-rater agreement.ResultsAcross the six survey dimensions, median Rwg(j) was sufficiently high to support shared climate perceptions (0.64–0.83), but varied widely across the 24 ED units. We provide an illustrative example showing vastly different climate strength (Rwg(j) range=0.17–0.86) for units with an equivalent level of PSC (eg, climate mean score=3).ConclusionsMost PSC survey results focus solely on climate level. To facilitate improvement in PSC, we advocate a simple, holistic safety climate profile including three metrics: climate level (using mean or per cent positive climate scores), climate strength (using the Rwg(j), or SD as a proxy) and the shape of the distribution (using histograms to see the distribution of scores within units). In PSC research, we advocate paying attention to climate strength as an important variable in its own right. Focusing on PSC level and strength can further understanding of the extent to which PSC is a key variable in the domain of patient safety.

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Assessing and improving safety climate in a large cohort of intensive care units*

Abstract: A patient safety program designed to improve teamwork and culture was associated with significant improvements in overall mean safety climate scores in a large cohort of 71 intensive care units. Research linking improved climate scores and clinical outcomes is a critical next step.

Cited by 172 publications

References 36 publications

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives

Patient safety climate strength: a concept that requires more attention

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