Association between organisational patient safety practices, safety culture and adverse event reporting in paediatric emergency departments in Spain: a multicentre cross-sectional survey study.

Abstract

To analyse the association between organisational patient safety practices, including training in patient safety and clinical simulation, and safety culture and adverse event (AE) reporting in paediatric emergency departments. Observational analytical multicentre cross-sectional study. 19 paediatric emergency departments at different levels of healthcare. Healthcare professionals working in paediatric emergency departments. Not applicable PRIMARY AND SECONDARY OUTCOMES: Safety culture was analysed using the Hospital Survey on Patient Safety Culture, following the Agency for Healthcare Research and Quality methodology. Logistic regression analyses were performed. Organisational patient safety practices included the presence of patient safety specialists, leadership walkarounds, additional reporting systems and training in patient safety and clinical simulation. A total of 1176 professionals participated (response rate 63.8%). The presence of patient safety specialists was associated with more favourable scores in 'supervisor/manager expectations and actions', 'organisational learning' and 'teamwork' (p<0.001). Additional reporting systems were associated with higher scores in <i>'</i>frequency of events reported<i>'</i> and <i>'</i>feedback<i>'</i> (p<0.001). Leadership walkarounds were associated with higher response rates in 'supervisor/manager expectations and actions' (p=0.013) and 'organisational learning' (p=0.048). Training in patient safety and clinical simulation were associated with higher positive response rates across most questionnaire dimensions. Higher AE reporting was observed in centres with clinical simulation training, presence of patient safety specialists, leadership walkarounds and additional reporting systems in bivariate analyses. However, in the multivariable model, only other reporting systems (OR 2.690; 95% CI 1.565 to 4.662) and annual emergency department visit volume (OR 1.023; 95% CI 1.1013 to 1.033) were independently associated with AE reporting. The presence of more than two patient safety specialists was associated with lower reporting (OR 0.553; 95% CI 0.306 to 0.998). Paediatricians were more likely to report AEs. Organisational patient safety practices were associated with favourable safety culture dimensions. However, after the adjustment, AE reporting was primarily associated with reporting infrastructure and organisational characteristics. The implementation of these practices varied across centres, highlighting differences in the availability of organisational safety practices. Further research is needed to better understand these associations in paediatric emergency departments.