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A1277
October 26, 2005 9:00:00 AM - 11:00:00 AM Hall C4 |
| Safety Culture Survey - A Tool To Uncover Patient Safety Opportunities in the Operating Room |
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Agnes Bognar, M.D., M.B.A., Igal Nevo, M.D., Julie Mohr, Ph.D., M.P.H., Robert Duncan, Ph.D., Paul Barach, M.D., M.P.H. Center for Patient Safety, Dept. of Anesthesiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, United States |
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Introduction An organization's patient safety culture is the product of individual and group values, perceptions, competencies, and patterns of behavior. We assessed the prevailing patient safety culture in pediatric cardiac surgery (PCS) as part of a larger effort to assess ways to improve patient safety in the operating room (OR). Methods PCS team members (anesthesiologists -11, surgeons - 3, perfusionists -8, nurses - 10) at two academic centers responded anonymously to the IRB approved written survey. We used a modified survey tool[i] and analyzed responses using quantitative and qualitative research methods. The questionnaire, composed of closed and open-ended questions, focused on the peri-operative period. In the closed-ended questions, respondents indicated their opinions using a four point scale (“1”- strongly disagree and “4” - strongly agree) about: a) a clinical vignette with an adverse event situation; b) patient safety; c) workload, staffing; and d) communication. In the open-ended questions, respondents described: 1) job related worries; 2) errors they observed; 3) patient safety lessons they would be willing to share with colleagues, and 4) recommendations to improve patient safety. The mean responses to closed questions first were tested against the scale's mean value of 2.5, and then were collapsed and recoded into two categories (agree vs. disagree) and analyzed using the Chi-square test. The responses to the open-ended questions were analyzed qualitatively by collating them into recurring themes. The number of respondents per theme and examples are presented. Results The overall response rate was 55% (32/59). In the closed-ended questions, all respondents indicated that they valued a culture that focused on preventing patient harm and on patient safety. However, 52.5% would not feel safe being a patient in their own OR. All groups concurred that: 1) communication and information sharing are very important; and 2) fatigue, excessive workload and frequent changes in schedule may impair performance. Nurses indicated that OR staffing levels were sufficient, while all other groups significantly disagreed (p=0.02)[ii] . Responses to the open-ended questions included: · 19 reported sometimes having difficulty sleeping because of: 1) fear of making an error or not giving the best care, especially to very complex patients (9); and 2) “hectic” schedule (4). · 20 wanted to share lessons about personally experienced or observed: 1) technical mishaps; or 2) action taken without adequate information. · 26 recommended ways to improve patient safety: 18 indicated that communication and information sharing among team members should be a top priority; 10 suggested that only trained and experienced staff should participate in PCS; 5 recommended to better enforce standards and procedures. Discussion The open-ended responses validated our hypothesis and offered clear examples of the responses to the closed-ended questions. This suggests that a safety culture survey is an effective tool to uncover safety problems in the OR and should be used in other healthcare settings. The survey should be complemented by observational studies to identify the extent of the safety problems and to prioritize corrective measures and interventions. [i] Sexton et al.: Frontline assessment of healthcare culture www.utpatientsafety.org [ii] Bognar et. al. (2005): Anesth Analg. (100) S-91 Anesthesiology 2005; 103: A1277 |