Hospital Safety Culture Influences Complications After Surgery

Each safety culture survey item was rated on a 1-5 scale, with lower scores representing better patient safety culture. The data were linked to clinical registry data for 24,117 bariatric surgery patients between 2007 and 2010. The researchers then calculated incidence rates and rate ratios measuring the increase in hospitals' rate of complications per unit increase in safety culture, controlling for patient risk factors, procedure mix, and bariatric procedure volume.

The results showed that the rates of serious complications were significantly lower among hospitals receiving an overall safety rating of excellent from nurses (1.5%), compared with those receiving a very good (2.6%) or acceptable (4.6%) rating. Surgeons' overall safety ratings were also associated with rates of serious complications (2.1% excellent, 2.6% very good, 4.7% acceptable). Nurses' ratings of the hospital-specific subscale and surgeons' ratings of the operating room-specific subscale were also associated with rates of serious complications.

Of the individual items surveyed, those related to coordination and communication between the different hospital units were the most strongly associated with rates of complications. Operating room administrator ratings of safety culture were not related to rates of complications for any of the domains of safety culture studied. The study was published ahead of print on October 8, 2012, in Annals of Surgery.

“Although nurses provide better information about hospital safety culture, surgeons are better judges of safety culture in the operating room,” concluded lead author Nancy Birkmeyer, PhD, from the Center for Healthcare Outcomes and Policy at U-M, and colleagues. “Interventions targeting safety culture, particularly coordination and communication, seem to be important for quality improvement.”

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