Improved Safety Culture and Teamwork Climate Are Associated With Decreases in Patient Harm and Hospital Mortality Across a Hospital System
Improved Safety Culture and Teamwork Climate Are Associated With Decreases in Patient Harm and Hospital Mortality Across a Hospital System
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DOI：
10.1097/pts.0000000000000251
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发表时间：
2020-06-01
影响因子：
2.2
通讯作者：
Brilli, Richard J.
中科院分区：
文献类型：
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作者：
Berry, Janet C.;Davis, John Terrance;Brilli, Richard J.
目的在医院或医院集团的特定单位内，安全性和团队合作文化的改善与患者伤害的减少有关。大多数研究都集中在一个特定的伤害类型。本研究的目的是记录整个医院系统和多种伤害类型之间的这种关联。方法在一家大型儿童医院建立全面的患者安全/高可靠性项目之前、之后2年和之后4年，对所有临床人员（包括医生）进行安全态度问卷调查（SAQ）。结果数据进行了分析，医院范围内，以及个别单位，医疗部门，和专业团体。结果3次调查中，安全态度得分提高（P< 0.05），团队合作态度得分提高（P=无显著性差异）。这些增加伴随着全医院伤害（P< 0.01），严重安全事件（P < 0.001）和严重程度调整的医院死亡率（P< 0.001）的统计学显著下降。医生和护士对个别单位内特定安全和团队合作项目的看法存在差异，护理得分往往较低。这些学科的具体差异随着时间的推移而减少。结论：SAQ测量的安全性和团队合作气氛的改善与患者伤害和严重程度调整死亡率的降低相关。不同职业群体的SAQ得分存在差异，但随着时间的推移而减少。
Objectives Improved safety and teamwork culture has been associated with decreased patient harm within specific units in hospitals or hospital groups. Most studies have focused on a specific harm type. This study's objective was to document such an association across an entire hospital system and across multiple harm types. Methods The Safety Attitudes Questionnaire (SAQ) was administered to all clinical personnel (including physicians) before, 2 years after, and 4 years after establishing a comprehensive patient safety/high-reliability program at a major children's hospital. Resultant data were analyzed hospital-wide as well as by individual units, medical sections, and professional groups. Results Safety attitude scores improved over the 3 surveys (P< 0.05) as did teamwork attitude scores (P= nonsignificant). These increases were accompanied by contemporaneous statistically significant decreases in all-hospital harm (P< 0.01), serious safety events (P< 0.001), and severity-adjusted hospital mortality (P< 0.001). Differences were noted between physicians' and nurses' views on specific safety and teamwork items within individual units, with nursing scores often lower. These discipline-specific differences decreased with time. Conclusions Improved safety and teamwork climate as measured by SAQ are associated with decreased patient harm and severity-adjusted mortality. Discrepancies in SAQ scores exist between different professional groups but decreased over time.