Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based ... more Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based on its Results Eric Thomas, Karen Mazzocco, Suzanne Graham, Diana Petitti, Kenneth Fong, Doug Bonacum, John Brookey, Robert Lasky and Bryan Sexton Introduction As ...
ImportanceExtraordinary strain from COVID-19 has negatively impacted health care worker (HCW) wel... more ImportanceExtraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being.ObjectiveTo determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point.Design, Setting, and ParticipantsThis survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US.ExposuresSafety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate.Main Outcomes and MeasuresThe percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-po...
Objective To assess maternal and neonatal healthcare workers (HCWs) perspectives on well-being an... more Objective To assess maternal and neonatal healthcare workers (HCWs) perspectives on well-being and patient safety amid the COVID-19 pandemic. Study design Anonymous survey of HCW well-being, burnout, and patient safety over the prior conducted in June 2020. Results were analyzed by job position and burnout status. Result We analyzed 288 fully completed surveys. In total, 66% of respondents reported symptoms of burnout and 73% felt burnout among their co-workers had significantly increased. Workplace strategies to address HCW well-being were judged by 34% as sufficient. HCWs who were "burned out" reported significantly worse well-being and patient safety attributes. Compared to physicians, nurses reported higher rates of unprofessional behavior (37% vs. 14%, p = 0.027) and difficulty focusing on work (59% vs. 36%, p = 0.013). Conclusion Three months into the COVID-19 pandemic, HCW well-being was substantially compromised, with negative ramifications for patient safety.
Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based ... more Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based on its Results Eric Thomas, Karen Mazzocco, Suzanne Graham, Diana Petitti, Kenneth Fong, Doug Bonacum, John Brookey, Robert Lasky and Bryan Sexton Introduction As ...
Purpose: A cross-sectional demonstration of the ability of interoperable health information excha... more Purpose: A cross-sectional demonstration of the ability of interoperable health information exchange and the electronic health record (EHR) to provide useful quality and safety measures. Scope: Use EHRs to understand better medication monitoring as it pertains to quality and safety in the ambulatory setting, using a set of national consensus measures and identify the organizational culture issues linked to accomplishing this for the vulnerable populations served by two clinics of Baltimore Medical System Community Health Center which had implemented EHR over a year ago. Methods: A cross sectional demonstration project of the equivalency and usefulness of IT-based quality measures fed back to the provider via monitoring bulletin. A single arm, pre/post intervention study was conducted using data from each round of bulletin distribution. 2,013 study eligible subjects were summarized in bivariate tests by overdue status using the χ2 test (categorical variables) and ANOVA (continuous variables) followed by logistic regression analyses. Results: 1) Automatic queries of EHRs to identify patients eligible for quality measures are feasible and potentially far superior to manual reviews of EHR data; 2) Only 1 to 5 providers described reports of quality measure data as useful. The percentage of patients receiving monitoring after appearing on the bulletin was not associated with provider attitudes about it's usefulness; 3) Individuals at risk for medication-related toxicity frequently go unmonitored. Provider-specific bulletins can enhance receipt of recommended monitoring among target patients; and 4) Low teamwork and safety climate was seen in 2007, and these scores were not significantly different in 2009.
The Joint Commission Journal on Quality and Patient Safety, 2020
Objective: This study was performed to determine whether health care worker (HCW) assessments of ... more Objective: This study was performed to determine whether health care worker (HCW) assessments of good institutional support for second victims were associated with institutional safety culture and workforce well-being. Methods: HCWs' awareness of work colleagues emotionally traumatized by an unanticipated clinical event (second victims), their perceptions of level of institutional support for such colleagues, safety culture, and workforce well-being were assessed using a cross-sectional survey (SCORE [Safety, Communication, Operational Reliability, and Engagement] survey). Safety culture scores and workforce well-being scores were compared across work settings with high (top quartile) and low (bottom quartile) perceptions of second victim support. Results: Of the 10,627 respondents (81.5% response rate), 36.3% knew at least one work colleague who had been traumatized by an unanticipated clinical event. Across 396 work settings, the percentage of respondents agreeing (slightly or strongly) that second victims receive appropriate support ranged from 0% to 100%. Across all respondents, significant correlations between perceived support for second victims and all SCORE domains (Improvement Readiness, Local Leadership, Teamwork Climate, Safety Climate, Emotional Exhaustion, Burnout Climate, and Work-Life Balance) were found. The 24.9% of respondents who knew an actual second victim and reported inadequate institutional support were significantly more negative in their assessments of safety culture and well-being than the 42.2% who reported adequate institutional support. Conclusion: Perceived institutional support for second victims was associated with a better safety culture and lower emotional exhaustion. Investment in programs to support second victims may improve overall safety culture and HCW wellbeing.
The measurement equivalence of job satisfaction ratings from physicians and nurses working in int... more The measurement equivalence of job satisfaction ratings from physicians and nurses working in intensive care units was tested in the present study. Seventy-two nurses and 72 physicians completed the Safety Attitudes Questionnaire, which contains five items about job satisfaction. Measurement equivalence across nurses and physicians of the job satisfaction ratings was examined via multiple-group confirmatory factor analysis. The results indicated that physicians and nurses use the same metric when providing ratings for this job satisfaction measure. The primary implication from the present study is that nurses and physicians conceptualize job satisfaction in a similar manner. This implication needs to be extended to other survey measures of interest to health services researchers. Future areas of research are discussed.
Researchers and team training programmes in commercial aviation identify specific teamwork behavi... more Researchers and team training programmes in commercial aviation identify specific teamwork behaviours, or behavioural markers, that can be used to measure and improve teamwork among cockpit crews. N Similarly, we used information from surveys, focus groups, and video recordings of neonatal healthcare providers to define a set of 10 behavioural markers for measuring teamwork during neonatal resuscitation. N We then developed the behavioural marker audit form to assess the following behavioural markers for neonatal resuscitation: information sharing, inquiry, assertion, intentions verbalised, teaching, evaluation of plans, workload management, vigilance, leadership, and teamwork overall.
Objectives To evaluate the extent to which intensive care units participating in the initial Keys... more Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients' safety. Setting Intensive care units predominantly in Michigan, USA. Intervention Conceptual model aimed at improving clinicians' use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. Main outcome measures Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention). Results Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (−1%, 95% confidence interval −9% to 7%). Conclusions The reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2012
background-NICU safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies w... more background-NICU safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies widely. Associations with clinical outcomes in the adult ICU setting make the SAQ an attractive tool for comparing clinical performance between hospitals. Little information is available on the use of the SAQ for this purpose in the NICU setting. objectives-To determine whether the dimensions of safety culture measured by the SAQ give consistent results when used as a NICU performance measure.
Background: Improving patient safety is an increasing priority for surgeons and hospitals since s... more Background: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist. Methods: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis. The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (␣ ϭ 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital ͓MANOVA omnibus F (59, 1910) ϭ 3.85, P Ͻ 0.001͔, but not position ͓ANOVA F (4, 1910) ϭ 1.64, P ϭ 0.16͔, surgeon (mean ϭ 73.91), technician (mean ϭ 70.26), anesthesiologist (mean ϭ 71.57), CRNA (mean ϭ 71.03), and nurse (mean ϭ 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%. Conclusions: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety.
Leadership walkrounds (WRs) are widely used in health care organizations to improve patient safet... more Leadership walkrounds (WRs) are widely used in health care organizations to improve patient safety. This retrospective, cross-sectional study evaluated the association between WRs and caregiver assessments of patient safety climate and patient safety risk reduction across 49 hospitals in a nonprofit health care system. Linear regression analyses using units' participation in WRs were conducted. Survey results from 706 hospital units revealed that units with ≥ 60% of caregivers reporting exposure to at least 1 WR had a significantly higher safety climate, greater patient safety risk reduction, and a higher proportion of feedback on actions taken as a result of WRs compared with those units with <60% of caregivers reporting exposure to WRs. WR participation at the unit level reflects a frequency effect as a function of units with none/low, medium, and high leadership WR exposure.
Objective Test web-based implementation for the science of enhancing resilience (WISER) intervent... more Objective Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. Design RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. Results Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (−5.27 (95% CI: −10.44, −0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (−6.3% (95%CI: −11.6%, −1.0%); p = 0.008), and secondary outcomes depression (−5.2% (95%CI: −10.8, −0.4); p = 0.022) and work-life integration (−11.8% (95%CI: −17.9, −6.1); p
The goal of this study was to implement an evidence-based teamwork system to improve communicatio... more The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team-work climate across team members both before and after implementation. Members of a change team (including master trainers) selected specific tools available within TeamSTEPPS to implement into an academic interventional ultrasound service. Tools selected were based on preimplementation survey data obtained from team members (n = 64: 11 attending faculty physicians, 12 clinical abdominal imaging fellows or residents, 17 sonographers, 19 nurses, and five technologist aides or administrative personnel). The survey included teamwork climate and safety climate domains from the Safety Attitudes Questionnaire. Four months after implementation, respondents were resurveyed and post-implementation data were collected. Teamwork climate scores improved ...
Human performance in extreme environments : the journal of the Society for Human Performance in Extreme Environments, 2000
The importance of communication on the flightdeck is discussed and the application of a new compu... more The importance of communication on the flightdeck is discussed and the application of a new computer-based linguistic method of text analysis is introduced. Preliminary results from a NASA B727 simulator study indicate that specific language variables are moderately to highly correlated with individual performance, individual error rates, and individual communication ratings. Also, language use was found to vary as a function of crew position and level of workload during the flight. Use of the first person plural (we, our, us) increases over the life of a flightcrew, and Captains speak more in the first person plural than First Officers or Flight Engineers. Language use in initial flights was associated with performance and error in subsequent flights. These are preliminary data, in that this method of linguistic analysis is currently being developed and integrated with a content-coding method of communication analysis and models of threat and error.
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2011
The Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient saf... more The Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient safety and clinical outcomes in adult ICUs through a unit-based patient safety program and evidenced-based practices. Few studies have shown how to draw on a strong safety culture to improve clinical outcomes. A study was conducted to (1) examine the impact of a Safety Attitudes Questionnaire Action Plan (SAQAP) on the 2008 Safety Attitudes Questionnaire (SAQ) and (2) determine the impact of an SAQAP on ICU central line-associated blood stream infections (CLABSIs) and ventilator-associated pneumonia (VAP) rates. The SAQ was administered at 23 ICUs in 11 hospitals in fall 2007 and 2008. Units were surveyed as to whether they completed an SAQAP on the basis of 2007 SAQ results. Annual rates of infection were submitted as unadjusted monthly CLABSI infections per 1,000 line days and VAP infections per 1,000 ventilator days for 2007 and 2008. SAQAPs were completed on 9 (39%) of the 23 units. Uni...
In the process of acquiring new skills, physicians-in-training may expose patients to harm becaus... more In the process of acquiring new skills, physicians-in-training may expose patients to harm because they lack the required experience, knowledge and technical skills. Yet, most teaching hospitals use inexperienced residents to care for high-acuity patients in complex and dynamic environments and provide limited supervision from experienced clinicians. Multiple efforts in the last few years have started to address the problem of patient safety. Examples include voluntary incident-reporting systems and team training workshops for practising clinicians. Fewer efforts have addressed the deficits in training new physicians, especially related to knowledge, skills and competence. The current apprenticeship or "see one, do one, teach one" model is insufficient because trainees learn by practising on real patients, which is particularly an issue when performing procedures. Residents have expressed that they do not feel adequately trained to perform procedures safely by themselves. In this paper, we conduct an informal review of the impact of current training methods on patient safety. In addition, we propose a new training paradigm that integrates competency-based knowledge and clinical skills, with deliberate attitudinal and behavioural changes focused on patient safety in a safe medically simulated environment. We do so with the hope of creating a better marriage between the missions of training and patient safety.
International Journal for Quality in Health Care, 2010
Objective. Safety culture may influence patient outcomes, but evidence is limited. We sought to d... more 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.
A proposed public-private partnership to help the health care community emulate the successes of ... more A proposed public-private partnership to help the health care community emulate the successes of CAST in commercial aviation.
Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based ... more Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based on its Results Eric Thomas, Karen Mazzocco, Suzanne Graham, Diana Petitti, Kenneth Fong, Doug Bonacum, John Brookey, Robert Lasky and Bryan Sexton Introduction As ...
ImportanceExtraordinary strain from COVID-19 has negatively impacted health care worker (HCW) wel... more ImportanceExtraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being.ObjectiveTo determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point.Design, Setting, and ParticipantsThis survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US.ExposuresSafety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate.Main Outcomes and MeasuresThe percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-po...
Objective To assess maternal and neonatal healthcare workers (HCWs) perspectives on well-being an... more Objective To assess maternal and neonatal healthcare workers (HCWs) perspectives on well-being and patient safety amid the COVID-19 pandemic. Study design Anonymous survey of HCW well-being, burnout, and patient safety over the prior conducted in June 2020. Results were analyzed by job position and burnout status. Result We analyzed 288 fully completed surveys. In total, 66% of respondents reported symptoms of burnout and 73% felt burnout among their co-workers had significantly increased. Workplace strategies to address HCW well-being were judged by 34% as sufficient. HCWs who were "burned out" reported significantly worse well-being and patient safety attributes. Compared to physicians, nurses reported higher rates of unprofessional behavior (37% vs. 14%, p = 0.027) and difficulty focusing on work (59% vs. 36%, p = 0.013). Conclusion Three months into the COVID-19 pandemic, HCW well-being was substantially compromised, with negative ramifications for patient safety.
Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based ... more Chapter 16 An Empiric Study of Surgical Team Behaviours, Patient Outcomes, and a Programme Based on its Results Eric Thomas, Karen Mazzocco, Suzanne Graham, Diana Petitti, Kenneth Fong, Doug Bonacum, John Brookey, Robert Lasky and Bryan Sexton Introduction As ...
Purpose: A cross-sectional demonstration of the ability of interoperable health information excha... more Purpose: A cross-sectional demonstration of the ability of interoperable health information exchange and the electronic health record (EHR) to provide useful quality and safety measures. Scope: Use EHRs to understand better medication monitoring as it pertains to quality and safety in the ambulatory setting, using a set of national consensus measures and identify the organizational culture issues linked to accomplishing this for the vulnerable populations served by two clinics of Baltimore Medical System Community Health Center which had implemented EHR over a year ago. Methods: A cross sectional demonstration project of the equivalency and usefulness of IT-based quality measures fed back to the provider via monitoring bulletin. A single arm, pre/post intervention study was conducted using data from each round of bulletin distribution. 2,013 study eligible subjects were summarized in bivariate tests by overdue status using the χ2 test (categorical variables) and ANOVA (continuous variables) followed by logistic regression analyses. Results: 1) Automatic queries of EHRs to identify patients eligible for quality measures are feasible and potentially far superior to manual reviews of EHR data; 2) Only 1 to 5 providers described reports of quality measure data as useful. The percentage of patients receiving monitoring after appearing on the bulletin was not associated with provider attitudes about it's usefulness; 3) Individuals at risk for medication-related toxicity frequently go unmonitored. Provider-specific bulletins can enhance receipt of recommended monitoring among target patients; and 4) Low teamwork and safety climate was seen in 2007, and these scores were not significantly different in 2009.
The Joint Commission Journal on Quality and Patient Safety, 2020
Objective: This study was performed to determine whether health care worker (HCW) assessments of ... more Objective: This study was performed to determine whether health care worker (HCW) assessments of good institutional support for second victims were associated with institutional safety culture and workforce well-being. Methods: HCWs' awareness of work colleagues emotionally traumatized by an unanticipated clinical event (second victims), their perceptions of level of institutional support for such colleagues, safety culture, and workforce well-being were assessed using a cross-sectional survey (SCORE [Safety, Communication, Operational Reliability, and Engagement] survey). Safety culture scores and workforce well-being scores were compared across work settings with high (top quartile) and low (bottom quartile) perceptions of second victim support. Results: Of the 10,627 respondents (81.5% response rate), 36.3% knew at least one work colleague who had been traumatized by an unanticipated clinical event. Across 396 work settings, the percentage of respondents agreeing (slightly or strongly) that second victims receive appropriate support ranged from 0% to 100%. Across all respondents, significant correlations between perceived support for second victims and all SCORE domains (Improvement Readiness, Local Leadership, Teamwork Climate, Safety Climate, Emotional Exhaustion, Burnout Climate, and Work-Life Balance) were found. The 24.9% of respondents who knew an actual second victim and reported inadequate institutional support were significantly more negative in their assessments of safety culture and well-being than the 42.2% who reported adequate institutional support. Conclusion: Perceived institutional support for second victims was associated with a better safety culture and lower emotional exhaustion. Investment in programs to support second victims may improve overall safety culture and HCW wellbeing.
The measurement equivalence of job satisfaction ratings from physicians and nurses working in int... more The measurement equivalence of job satisfaction ratings from physicians and nurses working in intensive care units was tested in the present study. Seventy-two nurses and 72 physicians completed the Safety Attitudes Questionnaire, which contains five items about job satisfaction. Measurement equivalence across nurses and physicians of the job satisfaction ratings was examined via multiple-group confirmatory factor analysis. The results indicated that physicians and nurses use the same metric when providing ratings for this job satisfaction measure. The primary implication from the present study is that nurses and physicians conceptualize job satisfaction in a similar manner. This implication needs to be extended to other survey measures of interest to health services researchers. Future areas of research are discussed.
Researchers and team training programmes in commercial aviation identify specific teamwork behavi... more Researchers and team training programmes in commercial aviation identify specific teamwork behaviours, or behavioural markers, that can be used to measure and improve teamwork among cockpit crews. N Similarly, we used information from surveys, focus groups, and video recordings of neonatal healthcare providers to define a set of 10 behavioural markers for measuring teamwork during neonatal resuscitation. N We then developed the behavioural marker audit form to assess the following behavioural markers for neonatal resuscitation: information sharing, inquiry, assertion, intentions verbalised, teaching, evaluation of plans, workload management, vigilance, leadership, and teamwork overall.
Objectives To evaluate the extent to which intensive care units participating in the initial Keys... more Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients' safety. Setting Intensive care units predominantly in Michigan, USA. Intervention Conceptual model aimed at improving clinicians' use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. Main outcome measures Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention). Results Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (−1%, 95% confidence interval −9% to 7%). Conclusions The reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2012
background-NICU safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies w... more background-NICU safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies widely. Associations with clinical outcomes in the adult ICU setting make the SAQ an attractive tool for comparing clinical performance between hospitals. Little information is available on the use of the SAQ for this purpose in the NICU setting. objectives-To determine whether the dimensions of safety culture measured by the SAQ give consistent results when used as a NICU performance measure.
Background: Improving patient safety is an increasing priority for surgeons and hospitals since s... more Background: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist. Methods: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis. The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (␣ ϭ 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital ͓MANOVA omnibus F (59, 1910) ϭ 3.85, P Ͻ 0.001͔, but not position ͓ANOVA F (4, 1910) ϭ 1.64, P ϭ 0.16͔, surgeon (mean ϭ 73.91), technician (mean ϭ 70.26), anesthesiologist (mean ϭ 71.57), CRNA (mean ϭ 71.03), and nurse (mean ϭ 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%. Conclusions: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety.
Leadership walkrounds (WRs) are widely used in health care organizations to improve patient safet... more Leadership walkrounds (WRs) are widely used in health care organizations to improve patient safety. This retrospective, cross-sectional study evaluated the association between WRs and caregiver assessments of patient safety climate and patient safety risk reduction across 49 hospitals in a nonprofit health care system. Linear regression analyses using units' participation in WRs were conducted. Survey results from 706 hospital units revealed that units with ≥ 60% of caregivers reporting exposure to at least 1 WR had a significantly higher safety climate, greater patient safety risk reduction, and a higher proportion of feedback on actions taken as a result of WRs compared with those units with <60% of caregivers reporting exposure to WRs. WR participation at the unit level reflects a frequency effect as a function of units with none/low, medium, and high leadership WR exposure.
Objective Test web-based implementation for the science of enhancing resilience (WISER) intervent... more Objective Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. Design RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. Results Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (−5.27 (95% CI: −10.44, −0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (−6.3% (95%CI: −11.6%, −1.0%); p = 0.008), and secondary outcomes depression (−5.2% (95%CI: −10.8, −0.4); p = 0.022) and work-life integration (−11.8% (95%CI: −17.9, −6.1); p
The goal of this study was to implement an evidence-based teamwork system to improve communicatio... more The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team-work climate across team members both before and after implementation. Members of a change team (including master trainers) selected specific tools available within TeamSTEPPS to implement into an academic interventional ultrasound service. Tools selected were based on preimplementation survey data obtained from team members (n = 64: 11 attending faculty physicians, 12 clinical abdominal imaging fellows or residents, 17 sonographers, 19 nurses, and five technologist aides or administrative personnel). The survey included teamwork climate and safety climate domains from the Safety Attitudes Questionnaire. Four months after implementation, respondents were resurveyed and post-implementation data were collected. Teamwork climate scores improved ...
Human performance in extreme environments : the journal of the Society for Human Performance in Extreme Environments, 2000
The importance of communication on the flightdeck is discussed and the application of a new compu... more The importance of communication on the flightdeck is discussed and the application of a new computer-based linguistic method of text analysis is introduced. Preliminary results from a NASA B727 simulator study indicate that specific language variables are moderately to highly correlated with individual performance, individual error rates, and individual communication ratings. Also, language use was found to vary as a function of crew position and level of workload during the flight. Use of the first person plural (we, our, us) increases over the life of a flightcrew, and Captains speak more in the first person plural than First Officers or Flight Engineers. Language use in initial flights was associated with performance and error in subsequent flights. These are preliminary data, in that this method of linguistic analysis is currently being developed and integrated with a content-coding method of communication analysis and models of threat and error.
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2011
The Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient saf... more The Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient safety and clinical outcomes in adult ICUs through a unit-based patient safety program and evidenced-based practices. Few studies have shown how to draw on a strong safety culture to improve clinical outcomes. A study was conducted to (1) examine the impact of a Safety Attitudes Questionnaire Action Plan (SAQAP) on the 2008 Safety Attitudes Questionnaire (SAQ) and (2) determine the impact of an SAQAP on ICU central line-associated blood stream infections (CLABSIs) and ventilator-associated pneumonia (VAP) rates. The SAQ was administered at 23 ICUs in 11 hospitals in fall 2007 and 2008. Units were surveyed as to whether they completed an SAQAP on the basis of 2007 SAQ results. Annual rates of infection were submitted as unadjusted monthly CLABSI infections per 1,000 line days and VAP infections per 1,000 ventilator days for 2007 and 2008. SAQAPs were completed on 9 (39%) of the 23 units. Uni...
In the process of acquiring new skills, physicians-in-training may expose patients to harm becaus... more In the process of acquiring new skills, physicians-in-training may expose patients to harm because they lack the required experience, knowledge and technical skills. Yet, most teaching hospitals use inexperienced residents to care for high-acuity patients in complex and dynamic environments and provide limited supervision from experienced clinicians. Multiple efforts in the last few years have started to address the problem of patient safety. Examples include voluntary incident-reporting systems and team training workshops for practising clinicians. Fewer efforts have addressed the deficits in training new physicians, especially related to knowledge, skills and competence. The current apprenticeship or "see one, do one, teach one" model is insufficient because trainees learn by practising on real patients, which is particularly an issue when performing procedures. Residents have expressed that they do not feel adequately trained to perform procedures safely by themselves. In this paper, we conduct an informal review of the impact of current training methods on patient safety. In addition, we propose a new training paradigm that integrates competency-based knowledge and clinical skills, with deliberate attitudinal and behavioural changes focused on patient safety in a safe medically simulated environment. We do so with the hope of creating a better marriage between the missions of training and patient safety.
International Journal for Quality in Health Care, 2010
Objective. Safety culture may influence patient outcomes, but evidence is limited. We sought to d... more 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.
A proposed public-private partnership to help the health care community emulate the successes of ... more A proposed public-private partnership to help the health care community emulate the successes of CAST in commercial aviation.
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Papers by Bryan Sexton