Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions
Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions
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DOI：
10.1016/j.jamcollsurg.2007.07.039
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发表时间：
2007-12-01
影响因子：
5.2
通讯作者：
Mentzer, Robert M., Jr.
中科院分区：
文献类型：
--
作者：
Davenport, Daniel L.;Henderson, William G.;Mentzer, Robert M., Jr.
背景技术背景：自从医学研究所的患者安全报告以来，已经开发了一些基于调查的组织气候安全因素（OCSFs）措施。本研究的目的是衡量的影响，OCSFs风险调整后的手术发病率和mortality.Study Design：调查管理的工作人员在一年的一般/血管外科服务。调查包括测量OCSF的多项量表。此外，与同事的沟通和协作的感知水平进行了评估。国家手术质量改进计划被用来评估风险调整后的发病率和死亡率。计算结果与OCSF之间的相关性，以及结果与主治和住院医生、护士和其他提供者的沟通/协作之间的相关性。结果：52个地点参与了调查：44个退伍军人事务部和8个学术医疗中心。共收到6，083份调查问卷，回复率为52%。团队合作气氛，安全气氛，工作条件，认识到压力的影响，工作满意度和倦怠的OCSF措施表现出内部效度，但与风险调整后的结果不相关。报告的沟通/协作水平与主治和住院医生risk-adjusted morbidity.CONCLUSIONS：调查为基础的团队合作，安全气候，和工作条件的规模没有得到证实，以衡量组织因素，影响风险调整后的手术结果。报告的沟通/协作与主治医生和住院医生对手术服务的影响患者的发病率这表明医生的协调和决策作用的重要性，在提供高质量和安全的护理手术团队。我们建议将风险调整后的发病率作为衡量手术患者安全性的有效指标。
BACKGROUND: Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality.STUDY DESIGN: Surveys were administered to staff on general/vascular surgery services during a year. Surveys included multiitem scales measuring OCSFs. Additionally, perceived levels of communication and collaboration with coworkers were assessed. The National Surgical Quality Improvement Program was used to assess risk-adjusted morbidity and mortality. Correlations between outcomes and OCSFs were calculated and between outcomes and communication/collaboration with attending and resident doctors, nurses, and other providers.RESULTS: Fifty-two sites participated in the survey: 44 Veterans Affairs and 8 academic medical centers. A total of 6,083 surveys were returned, for a response rate of 52%. The OCSF measures of teamwork climate, safety climate, working conditions, recognition of stress effects, job satisfaction, and burnout demonstrated internal validity but did not correlate with risk-adjusted outcomes. Reported levels of communication/collaboration with attending and resident doctors correlated with risk-adjusted morbidity.CONCLUSIONS: Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.