Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont.
CMAJ Open. 2021 Nov 23;9(4):E1041-E1047. doi: 10.9778/cmajo.20200266. Print 2021 Oct-Dec.
Substantial expenditures on health care safety programs have been justified by their goal of reducing health care associated-harm (adverse events), but adverse event rates have not changed over the past 4 decades. The objective of this study is to describe hospital-level factors that are relevant to safety in Canadian hospitals and the impact of these factors on hospital adverse events.
This is a protocol for a national cohort study to describe the association between hospital-level factors and adverse events. We will survey at least 90 (35%) Canadian hospitals to describe 4 safety-relevant domains, chosen based on the literature and expert consultation, namely patient safety culture, safety strategies, staffing, and volume and capacity. We will retrospectively identify hospital adverse events from a national data source. We will evaluate organization-level factors using established scales and a survey, codesigned by the study team and hospital leaders. Hospital leaders, clinical unit leaders and front-line staff will complete the surveys once a year for 3 years, with an anticipated start date of winter 2022. We will use national health administrative data to estimate the rate and type of hospital adverse events corresponding to each 1-year survey period.
Analysis of data from this project will describe hospital organizational factors that are relevant to safety and help identify organizational initiatives that improve hospital patient safety. In addition to biyearly reports to the leaders of the participating hospitals, we have a multifaceted and tailored dissemination strategy that includes integrating the knowledge users into the study team to increase the likelihood that our study will lead to improved hospital patient safety.
医疗保健安全计划的大量支出是合理的，因为它们的目标是减少与医疗保健相关的伤害（不良事件），但在过去的 40 年中，不良事件的发生率并没有改变。本研究的目的是描述与加拿大医院安全相关的医院层面的因素，以及这些因素对医院不良事件的影响。
这是一项全国性队列研究的方案，旨在描述医院层面因素与不良事件之间的关联。我们将调查至少 90 家（35%）加拿大医院，以描述基于文献和专家咨询选择的 4 个安全相关领域，即患者安全文化、安全策略、人员配备以及数量和容量。我们将从国家数据来源中回顾性地确定医院不良事件。我们将使用既定的量表和由研究团队和医院领导共同设计的调查来评估组织层面的因素。医院领导、临床科室领导和一线工作人员将在未来 3 年内每年完成一次调查，预计 2022 年冬季开始。我们将使用国家卫生行政数据估计与每 1 年调查期相对应的医院不良事件的发生率和类型。
该项目数据分析将描述与安全相关的医院组织因素，并有助于确定改善医院患者安全的组织举措。除了向参与医院的领导每两年报告一次结果外，我们还制定了一个多方面、量身定制的传播策略，包括将知识用户纳入研究团队，以增加我们的研究将导致改善医院患者安全的可能性。
