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Sustained Improvement in Neonatal Intensive Care Unit Safety Attitudes After Teamwork Training

Murphy, Thomas, MD; Laptook, Abbot, MD; Bender, Jesse, MD

doi: 10.1097/PTS.0000000000000191
Original Articles

Objectives This study aimed to measure safety attitudes in the neonatal intensive care unit (NICU) before and serially after a compulsory, multidisciplinary teamwork and communication training initiative and novel sustainment program.

Methods Training was administered to NICU staff and subsequent sustainment efforts were directed at enculturating core principles over the following year. A modified Agency for Healthcare Research and Quality Survey on Patient Safety Culture was administered before as well as 3 and 12 months after training. Longitudinal survey results were compared with the national Agency for Healthcare Research and Quality survey data.

Results Ninety-six percent of 350 NICU staff were trained over 2 months. Survey response rates were 84%, 71%, and 83% before, at 3 months, and at 12 months after training, respectively. Items with sustained improvement pertained to staff empowerment and patient hand-offs. The proportion of participants who agreed with the statement, “Staff feel free to question the decisions or actions of those with more authority” increased from 55% to 76% and 83% at 3 and 12 months, respectively (P < 0.0001). The proportion of participants who disagreed with the statement, “Things ‘fall between the cracks’ when transferring patients from one unit to another” increased from 36% to 48% and 52% at 3 and 12 months, respectively (P < 0.01). The only significant decline was for the statement, “We are actively doing things to improve patient safety.” The proportion of respondents who agreed dropped from 93% to 83% at 3 months (P = 0.02).

Conclusions A novel sustainment program after teamwork and communication training measurably improved most staff safety attitudes over 1 year.

From the Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.

Correspondence: Thomas Murphy, MD, Department of Pediatrics, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905 (e-mail:

The authors disclose no conflict of interest.

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