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Multicenter Study
. 2006 May;243(5):628-32; discussion 632-5.
doi: 10.1097/01.sla.0000216410.74062.0f.

Patient safety in surgery

Martin A Makary  1 , J Bryan Sexton, Julie A Freischlag, E Anne Millman, David Pryor, Christine Holzmueller, Peter J Pronovost
Affiliations
Multicenter Study

Patient safety in surgery

Martin A Makary et al. Ann Surg. 2006 May.

Abstract

Background: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist.

Methods: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis.

Results: The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (alpha = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%.

Conclusions: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety.

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Figures

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FIGURE 1. Safety climate by position.
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FIGURE 2. Safety climate by hospital (each bar represents one hospital).
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FIGURE 3. Donabedian model for measuring quality. Type of measures: structure, process, outcome, or culture.
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FIGURE 4. Finding the sweet spot: Issues in improving patient safety.
See this image and copyright information in PMC

References

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