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Intensive care unit safety culture and outcomes: a US multicenter study.

Publication ,  Journal Article
Huang, DT; Clermont, G; Kong, L; Weissfeld, LA; Sexton, JB; Rowan, KM; Angus, DC
Published in: Int J Qual Health Care
June 2010

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. PARTICIPANTS: A total of 65 978 patients admitted January 2001-March 2005. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hospital mortality and length of stay (LOS). METHODS: From December 2003 to April 2004, we surveyed study ICUs using the Safety Attitudes Questionnaire-ICU version, a validated instrument that assesses safety culture across six factors. We calculated factor mean and percent-positive scores (% respondents with mean score > or =75 on a 0-100 scale) for each ICU, and generated case-mix adjusted, patient-level, ICU-clustered regression analyses to determine the independent association of safety culture and outcome. RESULTS: We achieved a 47.9% response (2103 of 4373 ICU personnel). Culture scores were mostly low to moderate and varied across ICUs (range: 13-88, percent-positive scores). After adjustment for patient, hospital and ICU characteristics, for every 10% decrease in ICU perceptions of management percent-positive score, the odds ratio for hospital mortality was 1.24 (95% CI: 1.07-1.44; P = 0.005). For every 10% decrease in ICU safety climate percent-positive score, LOS increased 15% (95% CI: 1-30%; P = 0.03). Sensitivity analyses for non-response bias consistently associated safety climate with outcome, but also yielded some counterintuitive results. CONCLUSION: In a multicenter study conducted in the USA, perceptions of management and safety climate were moderately associated with outcomes. Future work should further develop methods of assessing safety culture and association with outcomes.

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Published In

Int J Qual Health Care

DOI

EISSN

1464-3677

Publication Date

June 2010

Volume

22

Issue

3

Start / End Page

151 / 161

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Safety Management
  • Personnel Staffing and Scheduling
  • Perception
  • Organizational Culture
  • Length of Stay
  • Intensive Care Units
  • Humans
 

Citation

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Huang, D. T., Clermont, G., Kong, L., Weissfeld, L. A., Sexton, J. B., Rowan, K. M., & Angus, D. C. (2010). Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care, 22(3), 151–161. https://doi.org/10.1093/intqhc/mzq017
Huang, David T., Gilles Clermont, Lan Kong, Lisa A. Weissfeld, J Bryan Sexton, Kathy M. Rowan, and Derek C. Angus. “Intensive care unit safety culture and outcomes: a US multicenter study.Int J Qual Health Care 22, no. 3 (June 2010): 151–61. https://doi.org/10.1093/intqhc/mzq017.
Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, et al. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010 Jun;22(3):151–61.
Huang, David T., et al. “Intensive care unit safety culture and outcomes: a US multicenter study.Int J Qual Health Care, vol. 22, no. 3, June 2010, pp. 151–61. Pubmed, doi:10.1093/intqhc/mzq017.
Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, Angus DC. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010 Jun;22(3):151–161.
Journal cover image

Published In

Int J Qual Health Care

DOI

EISSN

1464-3677

Publication Date

June 2010

Volume

22

Issue

3

Start / End Page

151 / 161

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Safety Management
  • Personnel Staffing and Scheduling
  • Perception
  • Organizational Culture
  • Length of Stay
  • Intensive Care Units
  • Humans