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Critical Care Medicine:
doi: 10.1097/CCM.0b013e318206d26c
Feature Articles

Assessing and improving safety climate in a large cohort of intensive care units*

Bryan Sexton, J. PhD; Berenholtz, Sean M. MD, MHS; Goeschel, Christine A. RN, MPA, MPS; Watson, Sam R. MSA, MT(ASCP); Holzmueller, Christine G. BLA; Thompson, David A. DScN, RN; Hyzy, Robert C. MD; Marsteller, Jill A. PhD, MPP; Schumacher, Kathy MSA, CPHQ; Pronovost, Peter J. MD, PhD, FCCM

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Objectives: To evaluate the impact of a comprehensive unit-based safety program on safety climate in a large cohort of intensive care units participating in the Keystone intensive care unit project.

Design/Setting: A prospective cohort collaborative study to improve quality of care and safety culture by implementing and evaluating patient safety interventions in intensive care units predominantly in the state of Michigan.

Interventions: The comprehensive unit-based safety program was the first intervention implemented by every intensive care unit participating in the collaborative. It is specifically designed to improve the various elements of a unit's safety culture, such as teamwork and safety climate. We administered the validated Safety Attitudes Questionnaire at baseline (2004) and after 2 yrs of exposure to the safety program (2006) to assess improvement. The safety climate domain on the survey includes seven items.

Measurements and Main Results: Post-safety climate scores for intensive care units. To interpret results, a score of <60% was in the “needs improvement” zone and a ≥10-point discrepancy in pre-post scores was needed to describe a difference. Hospital bed size, teaching status, and faith-based status were included in our analyses. Seventy-one intensive care units returned surveys in 2004 and 2006 with 71% and 73% response rates, respectively. Overall mean safety climate scores significantly improved from 42.5% (2004) to 52.2% (2006), t = −6.21, p < .001, with scores higher in faith-based intensive care units and smaller-bed-size hospitals. In 2004, 87% of intensive care units were in the “needs improvement” range and in 2006, 47% were in this range or did not score ≥10 points or higher. Five of seven safety climate items significantly improved from 2004 to 2006.

Conclusions: A patient safety program designed to improve teamwork and culture was associated with significant improvements in overall mean safety climate scores in a large cohort of 71 intensive care units. Research linking improved climate scores and clinical outcomes is a critical next step.

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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