Makary Martin A, Sexton J Bryan, Freischlag Julie A, Millman E Anne, Pryor David, Holzmueller Christine, Pronovost Peter J
Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Ann Surg. 2006 May;243(5):628-32; discussion 632-5. doi: 10.1097/01.sla.0000216410.74062.0f.
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.
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 (alpha = 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) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%.
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.
提高患者安全是外科医生和医院日益重视的工作重点，因为警讯事件对患者、医护人员和医疗机构来说可能是灾难性的。旨在营造安全手术室文化的患者安全倡议越来越多地被采用，但目前尚不存在一种可靠的方法来衡量其对一线医护人员的影响。
我们开发了一份针对手术的安全调查问卷（SAQ），并将其分发给60家医院的2769名符合条件的医护人员。调查问题包括处理医疗差错的适当性、报告系统的知识以及对手术室安全性的认知。使用综合评分，通过多变量方差分析（MANOVA）和方差分析（ANOVA）来比较不同医院以及手术室中个人不同职位的安全结果。进行多水平验证性因素分析以在手术室层面分析验证该量表的结构。
总体回复率为77.1%（2769人中的2135人），范围在57%至100%之间。对调查项目的因素分析显示出较高的表面效度和内部一致性（α = 0.76）。安全氛围量表总体上以及在各个职位上都很稳健且内部一致。得分在不同医院间差异很大[多变量方差分析总体F（59, 1910）= 3.85，P < 0.001]，但在职位间无差异[方差分析F（4, 1910）= 1.64，P = 0.16]，外科医生（平均 = 73.91）、技术员（平均 = 70.26）、麻醉医生（平均 = 71.57）、注册护士麻醉师（平均 = 71.03）和护士（平均 = 70.40）。每家医院中报告良好安全氛围的受访者比例在16.3%至100%之间。
外科科室的安全氛围可以得到有效测量，且不同医院间差异很大，这为对标绩效提供了机会。SAQ得分可用于评估改善患者安全的干预措施。
