Center for Perioperative Research in Quality, 1211 21st Ave South, Suite 732, Nashville, TN 37212-1212, USA.
Med Care. 2010 Mar;48(3):279-84. doi: 10.1097/MLR.0b013e3181c162d6.
Learning about the factors that influence safety climate and improving the methods for assessing relative performance among hospital or units would improve decision-making for clinical improvement.
To measure safety climate in intensive care units (ICU) owned by a large for-profit integrated health delivery systems; identify specific provider, ICU, and hospital factors that influence safety climate; and improve the reporting of safety climate data for comparison and benchmarking.
We administered the Safety Attitudes Questionnaire (SAQ) to clinicians, staff, and administrators in 110 ICUs from 61 hospitals.
A total of 1502 surveys (43% response) from physicians, nurses, respiratory therapists, pharmacists, mangers, and other ancillary providers.
The survey measured safety climate across 6 domains: teamwork climate; safety climate; perceptions of management; job satisfaction; working conditions; and stress recognition. Percentage of positive scores, mean scores, unadjusted random effects, and covariate-adjusted random effect were used to rank ICU performance.
The cohort was characterized by a positive safety climate. Respondents scored perceptions of management and working conditions significantly lower than the other domains of safety climate. Respondent job type was significantly associated with safety climate and domain scores. There was modest agreement between ranking methodologies using raw scores and random effects.
The relative proportion of job type must be considered before comparing safety climate results across organizational units. Ranking methodologies based on raw scores and random effects are viable for feedback reports. The use of covariate-adjusted random effects is recommended for hospital decision-making.
了解影响安全氛围的因素，并改进评估医院或单位相对绩效的方法，将有助于临床改进决策。
测量大型营利性综合医疗服务系统所属重症监护病房（ICU）的安全氛围；确定影响安全氛围的特定提供者、ICU 和医院因素；并改进安全氛围数据的报告，以进行比较和基准测试。
我们向 61 家医院的 110 个 ICU 的临床医生、工作人员和管理人员发放了安全态度问卷（SAQ）。
来自 61 家医院的 1502 名医生、护士、呼吸治疗师、药剂师、经理和其他辅助人员的调查。
该调查衡量了 6 个领域的安全氛围：团队合作氛围；安全氛围；管理层看法；工作满意度；工作条件；以及压力识别。使用正分百分比、平均分数、未调整的随机效应和协变量调整的随机效应来对 ICU 绩效进行排名。
该队列的安全氛围特征为积极。受访者对管理层和工作条件的看法评分明显低于安全氛围的其他领域。受访者的工作类型与安全氛围和领域评分显著相关。使用原始分数和随机效应的排名方法之间存在适度的一致性。
在跨组织单位比较安全氛围结果之前，必须考虑工作类型的相对比例。基于原始分数和随机效应的排名方法适用于反馈报告。建议使用协变量调整的随机效应进行医院决策。
