Yonsei Med J.  2014 Mar;55(2):523-529.

Assessing Safety Attitudes among Healthcare Providers after a Hospital-Wide High-Risk Patient Care Program

• Je SM
• Kim HJ
• You JS
• Chung SP
• Cho J
• Lee JH
• Lee HS
• Chung HS

Abstract

PURPOSE
Cardiopulmonary resuscitation (CPR) is commonly performed in high-risk, high intensity situations and is therefore a good procedure around which to develop and implement safety culture strategies in the hospital. The purpose of this study was to evaluate the impact of a hospital-wide quality improvement program on the management of sudden cardiac arrests by assessing healthcare providers' attitudes towards patient safety.
MATERIALS AND METHODS
This study was designed as a prospective cohort study at a single academic medical center. The comprehensive hospital-based safety program included steps to identify areas of hazard, partner units with the Resuscitation Committee, and to conduct a Safety Attitudes Questionnaire (SAQ). The SAQ evaluated 35 questions in seven domains to assess changes in patient safety culture by comparing the results before and after the hospital-wide high risk patient care improvement program.
RESULTS
The response rates of the pre- and post-SAQ survey were 489 out of 1121 (43.6%) and 575 out of 1270 (45.3%), respectively. SAQ survey responses revealed significant improvement in all seven domains of the questionnaire (p-values of 0.006 and lower). In a subgroup analysis, doctors and nurses showed improvement in five domains. Both doctors and nurses did not show improvement in the "sharing information" domain.
CONCLUSION
A hospital-wide quality improvement program for high-risk, high reliability patient care involving CPR care was shown to be associated with a change in healthcare providers' attitudes towards patient safety. Through an immersive and active program on CPR care, change in healthcare providers' attitudes towards patient safety was initiated.

Keyword

Cardiopulmonary resuscitation; Safety Attitudes Questionnaire; system improvement

MeSH Terms

Academic Medical Centers
Cardiopulmonary Resuscitation
Cohort Studies
Death, Sudden, Cardiac
Delivery of Health Care*
Health Personnel*
Humans
Methods
Patient Care*
Patient Safety
Prospective Studies
Quality Improvement
Questionnaires
Resuscitation

Reference

1. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008; 17:216–223.

2. Kohn LT, Corrigan JM, Donaldson MS. America. Institute of Medicine. To err is human: building a safer health system. Washington, DC: Committee on Quality, National Academic Press;2000.

3. Graf J, Mühlhoff C, Doig GS, Reinartz S, Bode K, Dujardin R, et al. Health care costs, long-term survival, and quality of life following intensive care unit admission after cardiac arrest. Crit Care. 2008; 12:R92.

4. Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC. The culture of safety: results of an organization-wide survey in 15 California hospitals. Qual Saf Health Care. 2003; 12:112–118.

5. Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006; 6:44.

6. Korea Institute for Healthcare Accreditation. accessed on 2013 February 1. Available at: https://www.koiha.or.kr/english/index.act?page=AP.

7. Colla JB, Bracken AC, Kinney LM, Weeks WB. Measuring patient safety climate: a review of surveys. Qual Saf Health Care. 2005; 14:364–366.

8. Pronovost P, Sexton B. Assessing safety culture: guidelines and recommendations. Qual Saf Health Care. 2005; 14:231–233.

9. Sexton JB1, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000; 320:745–749.

10. Kim M. [The effectiveness of error reporting promoting strategy on nurse's attitude, patient safety culture, intention to report and reporting rate]. J Korean Acad Nurs. 2010; 40:172–181.

11. Schneider AP 2nd, Nelson DJ, Brown DD. In-hospital cardiopulmonary resuscitation: a 30-year review. J Am Board Fam Pract. 1993; 6:91–101.

12. Cooper S, Cade J. Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation. 1997; 35:17–22.

13. Sandroni C, Cavallaro F, Ferro G, Fenici P, Santangelo S, Tortora F, et al. A survey of the in-hospital response to cardiac arrest on general wards in the hospitals of Rome. Resuscitation. 2003; 56:41–47.

14. Zafari AM, Zarter SK, Heggen V, Wilson P, Taylor RA, Reddy K, et al. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol. 2004; 44:846–852.

15. Gabbott D, Smith G, Mitchell S, Colquhoun M, Nolan J, Soar J, et al. Cardiopulmonary resuscitation standards for clinical practice and training in the UK. Resuscitation. 2005; 64:13–19.

16. Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety: an elusive target. JAMA. 2006; 296:696–699.

17. Hunziker S, Johansson AC, Tschan F, Semmer NK, Rock L, Howell MD, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol. 2011; 57:2381–2388.

18. Patterson MD, Geis GL, LeMaster T, Wears RL. Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department. BMJ Qual Saf. 2013; 22:383–393.