S. T. Ward1, D. A. Campbell1, C. Friese2, J. B. Dimick1, A. A. Ghaferi1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,School Of Nursing,Ann Arbor, MI, USA
Introduction: Failure to rescue (FTR) is associated with multiple hospital macro-system factors such as hospital technology, nurse staffing and teaching status. However, these factors do not account for the majority of variation in FTR. Micro-system factors, including safety attitudes, have been proposed as a potential contributor to FTR. In this study, we investigate safety attitudes in hospitals with varying FTR rates.
Methods: Using prospectively collected data from the Michigan Surgical Quality Collaborative (MSQC), we identified 44,567 patients between 2008-2012 who underwent major general or vascular surgery procedures. Hospitals were divided into tertiles based on risk adjusted FTR rates. We then administered a Safety Attitude Questionnaire (SAQ) to nurses and physicians across surgical units in the state of Michigan. We examined the association between FTR rates and SAQ scores in two major domains— Teamwork Climate and Safety Climate.
Results: FTR rates across the tertiles were 8.9%, 16.5% and 19.9% respectively, p < 0.001. There were no significant differences in perceived Teamwork or Safety Climate between low and high FTR hospitals. The SAQ Teamwork Climate scores for all providers combined were 76, 78, and 76 from the lowest to highest FTR tertiles. The Safety Climate scores were 75, 77, and 75 from the lowest to highest FTR tertiles. When stratified by professional group, physicians tended to rate these two domains higher than nurses within the same FTR tertile.
Conclusion: There was no association between safety attitudes and FTR rates between hospitals. The SAQ may only represent a small snapshot of culture within a surgical unit. However, timely and effective rescue requires interdisciplinary and cross-unit responses to crisis. Therefore, developing an accurate hospital-wide barometer of safety attitudes is needed.
