David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California.
J Surg Res. 2020 Nov;255:311-318. doi: 10.1016/j.jss.2020.05.068. Epub 2020 Jun 25.
Trauma quality improvement (QI) has resulted in decreased trauma mortality and morbidity in high-income countries and has the potential to do the same in low- and middle-income countries. Effective implementation of QI programs relies on a foundational culture of patient safety; however, studies on trauma-related patient safety culture in Sub-Saharan Africa remain scarce. This study assesses baseline patient safety culture in Cameroon to best identify opportunities for improvement.
Over a 3-week period, the Hospital Survey on Patient Safety Culture was administered in three hospitals in the Littoral region of Cameroon. Percentages of positive responses (PPRs) were calculated across 42 items in 12 survey dimensions. A mixed-effects logistic regression model was used to summarize dimension-level percentages and confidence intervals.
A total of 179 trauma-related hospital personnel were surveyed with an overall response rate of 76.8%. High PPRs indicate favorable patient safety culture. Of the 12 dimensions evaluated by the Hospital Survey on Patient Safety Culture, nine had a PPR below 50%. Dimensions particularly pertinent in the context of QI include Nonpunitive Response to Errors with a PPR of 25.8% and Organization Learning-Continuous Improvement with a PPR of 64.7%.
The present study elucidates an opportunity for the development of trauma patient safety culture in Cameroon. Low PPR for Nonpunitive Response to Errors indicates a need to shift cultural paradigms from ascribing individual blame to addressing systemic shortcomings of patient care. Moving forward, data from this study will inform interventions to cultivate patient safety culture in partnering Cameroonian hospitals.
创伤质量改进（QI）已降低了高收入国家的创伤死亡率和发病率，并有潜力在中低收入国家产生同样的效果。QI 计划的有效实施依赖于患者安全的基础文化；然而，撒哈拉以南非洲与创伤相关的患者安全文化研究仍然很少。本研究评估了喀麦隆的基线患者安全文化，以最好地确定改进的机会。
在喀麦隆滨海地区的三家医院进行了为期 3 周的医院患者安全文化调查。在 12 个调查维度的 42 个项目中计算了阳性反应率（PPR）。使用混合效应逻辑回归模型总结了维度水平的百分比和置信区间。
共调查了 179 名与创伤相关的医院工作人员，总体反应率为 76.8%。高 PPR 表明患者安全文化良好。在医院患者安全文化调查评估的 12 个维度中，有 9 个维度的 PPR 低于 50%。在 QI 背景下特别相关的维度包括非惩罚性对待错误（PPR 为 25.8%）和组织学习-持续改进（PPR 为 64.7%）。
本研究阐明了在喀麦隆发展创伤患者安全文化的机会。非惩罚性对待错误的低 PPR 表明需要从归因于个人责任转变为解决患者护理的系统缺陷。展望未来，这项研究的数据将为在喀麦隆合作医院培养患者安全文化的干预措施提供信息。
