Improving hospital safety for patients with chronic kidney disease: a mixed methods study

Abstract

Background People living with chronic kidney disease (CKD) require complex medical management and may be frequently hospitalized. Patient safety incidents during hospitalization can result in serious complications which may negatively affect health outcomes. There has been limited examination of how these patients perceive their own safety. Objectives This study compared the safety perceptions of patients hospitalized with CKD using two approaches: (a) the Patient Measure of Safety (PMOS) questionnaire and (b) qualitative interviews. The study objectives were to: (1) assess concordance between qualitative and quantitative data on safety perceptions and (2) better understand safety as perceived by study participants. Methods A cross-sectional convergent mixed methods design was used. Integration at the reporting level occurred by weaving together patient narratives and survey domains through the use of a joint display. Interview data were merged with results of the PMOS on a case-by-case basis for analysis to assess for concordance or discordance between these approaches to safety data collection. Results Of the 30 inpatients with CKD, almost one quarter (23.3 %) of participants reported low levels of perceived safety in hospitals. Four major themes emerged from the interviews: receiving safe care; expecting to be taken care of; expecting to be cared for; and reporting safety concerns. Suboptimal communication, delays in care and concerns about technical aspects of care were common to both forms of data collection. Concordance was noted between qualitative and quantitative data with respect to communication/teamwork, respect and dignity, staff roles, and ward type/lay-out. While interviews allowed for participants to share specific concerns related to safety about quality of interpersonal interactions, use of the questionnaire alone did not capture this concern. Conclusions Safety issues are a concern for in-patients with CKD. Both quantitative and qualitative approaches provided important and complementary insights into these issues. Narratives were mostly concordant with questionnaire scores. Findings from this mixed methods study suggest that communication, interpersonal interactions, and delays in care were more concerning for participants than technical aspects of care. Eliciting the concerns of people with CKD in a systematic fashion, either through interviews or a survey, ensures that hospital safety improvement efforts focus on issues important to patients.

Perception of medical-surgical wards’ patients from safety culture: A cross-sectional and multicenter study

“…This result is consistent with Taylor et al study in Australia (32) and McEachan et al study in the United Kingdom (26). It should be noted that in the past there has been a significant relationship between communication and team working with the organization and planning of care and overall understanding of safety in New et al study in Canada (33). In the study by Schiavone et al in Italy, among the eight dimensions, the highest mean was related to the dimension of employee training (3.98) and then to the dimension of information (3.87) (21).…”

“…It should be noted that whether or not individuals participate in their own treatment decisions plays an important role in patients' understanding of safety culture (31). This finding, however, contradicted the study of New et al in Canada (33). This difference can be due to different cultural factors in communities and each organization.…”

“…different for gender, the average value of this dimension was higher in women. In the New 2020 study in Canada, the average total safety culture was not significantly related to gender (33).…”

Evaluation of Safety from the Perspective of Patients Hospitalized in Medical and Surgical Wards

“…Patients usually define safety-related factors as different dimensions of service quality. Since service quality and access to resources vary in different communities and even centers, patient reports and priorities set by them will also vary in different care centers [17,19].…”

“…The culture of patients and their different care needs cause different safety priorities in them [16]. In a study in Canada, renal patients considered the physical environment of the ward as the most important factor in ensuring their safety [17]. While Italian patients reported respect and dignity as their safety priority during treatment [18].…”