Profit Jochen, Sharek Paul J, Cui Xin, Nisbet Courtney C, Thomas Eric J, Tawfik Daniel S, Lee Henry C, Draper David, Sexton J Bryan
University of Texas at Houston - Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine; Stanford.
J Patient Saf. 2020 Dec;16(4):e310-e316. doi: 10.1097/PTS.0000000000000546.
Key validated clinical metrics are being used individually and in aggregate (Baby-MONITOR) to monitor the performance of neonatal intensive care units (NICUs). The degree to which perceptions of key components of safety culture, safety climate, and teamwork are related to aspects of NICU quality of care is poorly understood. The objective of this study was to test whether NICU performance on key clinical metrics correlates with caregiver perceptions of safety culture.
Cross-sectional study of 6253 very low-birth-weight infants in 44 NICUs. We measured clinical quality via the Baby-MONITOR and its nine risk-adjusted and standardized subcomponents (antenatal corticosteroids, hypothermia, pneumothorax, healthcare-associated infection, chronic lung disease, retinopathy screen, discharge on any human milk, growth velocity, and mortality). A voluntary sample of 2073 of 3294 eligible professional caregivers provided ratings of safety and teamwork climate using the Safety Attitudes Questionnaire. We examined NICU-level variation across clinical and safety culture ratings and conducted correlation analysis of these dimensions.
We found significant variation in clinical and safety culture metrics across NICUs. Neonatal intensive care unit teamwork and safety climate ratings were correlated with absence of healthcare-associated infection (r = 0.39 [P = 0.01] and r = 0.29 [P = 0.05], respectively). None of the other clinical metrics, individual or composite, were significantly correlated with teamwork or safety climate.
Neonatal intensive care unit teamwork and safety climate were correlated with healthcare-associated infections but not with other quality metrics. Linkages to clinical measures of quality require additional research.
关键的经过验证的临床指标正在被单独使用以及综合使用（婴儿监测指标体系）来监测新生儿重症监护病房（NICU）的绩效。对于安全文化、安全氛围和团队合作等关键要素的认知与NICU护理质量方面的关联程度，目前了解甚少。本研究的目的是测试NICU在关键临床指标上的表现是否与医护人员对安全文化的认知相关。
对44个NICU中的6253名极低出生体重婴儿进行横断面研究。我们通过婴儿监测指标体系及其九个经过风险调整和标准化的子指标（产前使用糖皮质激素、体温过低、气胸、医疗相关感染、慢性肺病、视网膜病变筛查、纯母乳喂养出院、生长速度和死亡率）来衡量临床质量。在3294名符合条件的专业医护人员中，有2073人自愿参与样本，使用安全态度问卷对安全和团队合作氛围进行评分。我们检查了各NICU在临床和安全文化评分方面的差异，并对这些维度进行了相关性分析。
我们发现各NICU在临床和安全文化指标方面存在显著差异。新生儿重症监护病房的团队合作和安全氛围评分与无医疗相关感染相关（分别为r = 0.39 [P = 0.01]和r = 0.29 [P = 0.05]）。其他临床指标，无论是单个指标还是综合指标，均与团队合作或安全氛围无显著相关性。
新生儿重症监护病房的团队合作和安全氛围与医疗相关感染相关，但与其他质量指标无关。与临床质量指标的关联需要进一步研究。
