Revealing and Resolving Patient Safety Defects: The Impact of Leadership WalkRounds on Frontline Caregiver Assessments of Patient Safety
Revealing and Resolving Patient Safety Defects: The Impact of Leadership WalkRounds on Frontline Caregiver Assessments of Patient Safety
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DOI：
10.1111/j.1475-6773.2008.00878.x
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发表时间：
2008-12-01
影响因子：
3.4
通讯作者：
Sexton, Bryan
中科院分区：
文献类型：
--
作者：
Frankel, Allan;Grillo, Sarah Pratt;Sexton, Bryan
评估严格WalkRounds对一线护理人员安全气候评估的影响，并阐明严格WalkRounds的步骤和实施。主要结局变量为基线和WalkRounds后安全态度问卷（SAQ）的安全气候评分。次要结局是通过WalkRounds引发的安全性问题。研究期间为2002年8月至2005年4月，七家医院在马萨诸塞州同意参加，该项目在所有病人护理areas.Prospective研究的影响，严格应用WalkRounds对前线护理人员的安全气候评估，在他们的病人护理区域。每周根据WalkRounds七步指南进行WalkRounds。SAQ在基线和WalkRounds实施后约18个月对患者护理领域的所有护理人员进行管理。七家医院中有两家遵守严格的WalkRounds方法;医院A是学术教学中心，医院B是社区教学医院。在21个患者护理领域中，62%的受访者在基线时和60%的WalkRounds后接受了SAQ调查。在基线时，21个护理区中有10个（48%）的安全气候评分低于60%，而WalkRounds后的三个护理区（14%）的安全气候评分低于60%，没有改善10分或更多。A医院的安全气候量表评分在基线时为62%，WalkRounds后为77%（t=2.67，p= 0.03），B医院在基线时为46%，WalkRounds后为56%（t=2.06，p= 0.06）。按类别划分的主要安全问题是设备/设施（A [26%]和B [33%]）和通信（A [24%]和B [18%]）。WalkRounds的实施需要强大的组织意愿;可持续性需要出色的项目管理和领导参与。在严格实施WalkRounds的患者护理领域，一线护理人员对患者安全的评估有所增加。SAQ的结果，如安全气候评分，促进质量改进工作的分流，并提供一线护理人员的共识评估，确定改进的主题。
To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds.Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas.Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas.Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t=2.67, p=.03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t=2.06, p=.06). Main safety issues by category were equipment/facility (A [26 percent] and B [33 percent]) and communication (A [24 percent] and B [18 percent]).WalkRounds implementation requires significant organizational will; sustainability requires outstanding project management and leadership engagement. In the patient care areas that rigorously implemented WalkRounds, frontline caregiver assessments of patient safety increased. SAQ results such as safety climate scores facilitate the triage of quality improvement efforts, and provide consensus assessments of frontline caregivers that identify themes for improvement.