A Four-Step Model for Improving Patient Safety Culture in Anesthesiology: A Prospective Cross-Sectional Study.

Abstract

The present study aims to describe the change in the perception of patient safety culture among physicians in the Department of Anesthesiology and Intensive Care Medicine at a regional hospital in Denmark after applying a structured patient safety culture program. A prospective cross-sectional experimental study was conducted. To improve patient safety culture, a four-step model was introduced. This included regular patient safety leadership rounds, simulation-based training, enhanced daily patient safety awareness, and strengthened clinical risk management. Perception of patient safety culture among physicians was monitored using the Safety Attitudes Questionnaire. Measurements were obtained before and during the implementation of the four-step model annually in a 5-year period. Data from 114 questionnaires from physicians were included. The results showed a significant improvement in perception of patient safety culture regarding safety climate and teamwork climate among physicians in general. Furthermore, we found an increase regarding stress recognition among junior doctors compared to specialist physicians. Finally, our results showed an initial drop in all three dimensions after the Covid-19-pandemic. Applying a structured, proactive four-step model consisting of patient safety leadership rounds, simulation-based training, patient safety awareness, and clinical management for improvement of patient safety culture can increase teamwork and safety climate among physicians, leading to a healthier and safer patient safety culture. The results show that both specialist physicians and junior doctors benefit from the interventions. More studies are recommended to further specify underlying causes for improvement of patient safety culture. This report presents perceptions about patient safety culture in an anesthesiology and intensive care department, and how this can be altered by a structured approach for improvement over a 4 year period. A combination of clinical rounds with focus on patient safety, simulation-training, daily patient safety awareness dialogue, and strengthened clinical risk management improved perceptions in junior and senior doctors, as well as relieved perceived stress. The impact on actual patient safety, or preventable adverse events, remains to be documented as the next step.