Centre of Research Excellence in Patient Safety, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia.
BMJ Qual Saf. 2013 Jan;22(1):11-8. doi: 10.1136/bmjqs-2011-000582. Epub 2012 Jul 31.
To determine the effectiveness of patient safety culture strategies to improve hospital patient safety climate.
Electronic search of the Cochrane Library, OVID Medline, Embase, CINAHL, proQuest and psychinfo databases, with manual searches of quality and safety websites, bibliographies of included articles and key journals.
English language studies published between January 1996 and April 2011 that measured the effectiveness of patient safety culture strategies using a quantitative measure of patient safety climate in a hospital setting. Studies included were randomised controlled trials (RCTs), non-RCTs, controlled before and after studies, interrupted time series and historically controlled studies.
Data extraction and critical appraisal were conducted by two independent reviewers. Study design, intervention, level of application, setting, study participants, safety climate outcome measures and implementation lessons were extracted from each article.
Over 2000 articles were screened, with 21 studies meeting the inclusion criteria, one cluster RCT, seven controlled before and after studies, and 13 historically controlled studies. There was marked methodological heterogeneity amongst studies. Impacts of 11 different strategies were reported. There was some evidence to support that leadership walk rounds (p=0.02) and multi-faceted unit-based programmes (p < 0.05) may have a positive impact on patient safety climate.
Despite strong face validity for a variety of patient safety culture strategies, there is limited evidence to support definitive impacts on patient safety climate outcomes. Organisations are advised to consider robust evaluation designs when implementing these potentially resource intensive strategies.
确定患者安全文化策略的有效性，以改善医院患者安全氛围。
电子检索 Cochrane 图书馆、OVID Medline、Embase、CINAHL、ProQuest 和 PsychINFO 数据库，并人工检索质量和安全网站、纳入文章的参考文献和主要期刊。
1996 年 1 月至 2011 年 4 月期间以英文发表的研究，使用医院环境中患者安全氛围的定量测量来衡量患者安全文化策略的有效性。纳入的研究包括随机对照试验（RCT）、非随机对照试验、对照前后研究、中断时间序列和历史对照研究。
两名独立评审员进行数据提取和批判性评价。从每篇文章中提取研究设计、干预措施、应用水平、设置、研究参与者、安全氛围测量结果和实施经验教训。
筛选了 2000 多篇文章，有 21 项研究符合纳入标准，包括一项集群 RCT、7 项对照前后研究和 13 项历史对照研究。研究之间存在明显的方法学异质性。报告了 11 种不同策略的影响。有一些证据表明，领导巡视（p=0.02）和多方面的基于单位的方案（p < 0.05）可能对患者安全氛围产生积极影响。
尽管各种患者安全文化策略具有很强的表面有效性，但仅有有限的证据支持它们对患者安全氛围结果的明确影响。建议组织在实施这些潜在资源密集型策略时考虑采用强有力的评估设计。
