Details

Autor(en) / Beteiligte

• Huang, David T.
• Clermont, Gilles
• Kong, Lan
• Weissfeld, Lisa A.
• Sexton, J. Bryan
• Rowan, Kathy M.
• Angus, Derek C.

Titel

Intensive care unit safety culture and outcomes: a US multicenter study

Ist Teil von

• International journal for quality in health care, 2010-06, Vol.22 (3), p.151-161

Ort / Verlag

England: Oxford University Press

Erscheinungsjahr

2010

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Objective Safety culture may influence patient outcomes, but evidence is limited. We sought to determine if intensive care unit (ICU) safety culture is independently associated with outcomes. Design Cohort study combining safety culture survey data with the Project IMPACT Critical Care Medicine (PICCM) clinical database. Setting Thirty ICUs participating in the PICCM database. Participants A total of 65 978 patients admitted January 2001–March 2005. Interventions None. Main outcome measures Hospital mortality and length of stay (LOS). Methods From December 2003 to April 2004, we surveyed study ICUs using the Safety Attitudes Questionnaire-ICU version, a validated instrument that assesses safety culture across six factors. We calculated factor mean and percent-positive scores (% respondents with mean score ≥75 on a 0–100 scale) for each ICU, and generated case-mix adjusted, patient-level, ICU-clustered regression analyses to determine the independent association of safety culture and outcome. Results We achieved a 47.9% response (2103 of 4373 ICU personnel). Culture scores were mostly low to moderate and varied across ICUs (range: 13–88, percent-positive scores). After adjustment for patient, hospital and ICU characteristics, for every 10% decrease in ICU perceptions of management percent-positive score, the odds ratio for hospital mortality was 1.24 (95% CI: 1.07–1.44; P = 0.005). For every 10% decrease in ICU safety climate percent-positive score, LOS increased 15% (95% CI: 1−30%; P = 0.03). Sensitivity analyses for non-response bias consistently associated safety climate with outcome, but also yielded some counterintuitive results. Conclusion In a multicenter study conducted in the USA, perceptions of management and safety climate were moderately associated with outcomes. Future work should further develop methods of assessing safety culture and association with outcomes.