PubMed Central® (PMC), the archive of biomedical and life sciences journal articles from the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM), recently released a significant patient safety article authored by Drexel College of Computing & Informatics (CCI) Interim Senior Associate Dean for Research and Professor Ellen Bass, PhD, with co-author Bat-Zion Hose, formerly of the University of Pennsylvania Perelman School of Medicine.
Dr. Bass's work, in collaboration with her co-author, delves into the critical aspects of improving patient safety in the intensive care unit (ICU), where more than 700,000 patients are admitted annually in the United States following surgery.
In this interview, Dr. Bass discusses the focus on safety culture, the significance of understanding and assessing it in the perioperative setting, and the next steps for her research.
Ellen Bass, PhD
What inspired you to focus on safety culture in the perioperative environment?
EB: ICU care is delivered by a multidisciplinary care team comprised of physicians, nurses, advanced practice providers, respiratory therapists, and other specialized care providers.
Over 700,000 patients annually in the United States are admitted to the ICU after surgery. They are at risk as actual or potential cardiopulmonary failure is the criterion driving ICU admission for most of these patients. Improving the safety of this patient care is a top priority in the perioperative environment in order to minimize preventable deaths, post-surgical complications, and preventable adverse events.
This manuscript was an offshoot of a National Heart, Lung, and Blood Institute of the U.S. (NHLBI)–funded research project (Handoffs and Transitions in Critical Care - Understanding Scalability, M. Lane-Fall (PI)) focused on standardizing operating room (OR) to ICU handoffs.
Can you elaborate on the significance of understanding and assessing safety culture in this specific setting?
EB: Safety culture is the collection of values, attitudes, and behaviors that an organization prioritizes when it comes to safety.
While there is an increasing interest in patient safety and in transforming culture in the perioperative environment, before this research was conducted it was not clear what methods were being used to understand, assess, and influence safety culture and climate.
What are the next steps for your research in this area?
EB: We are investigating determinants of OR-to-ICU handoff protocol adoption and use in adult and pediatric ICUs in five health systems.
Determinants (i.e., barriers, enablers) of the adoption and use of handoff protocols operate at multiple levels; there are relevant clinician-, team-, ICU-, and hospital-level determinants to consider. We are performing on-site mixed methods contextual inquiries to characterize determinants of handoff protocol adoption, use, and sustainment in ICUs caring for patients with a range of surgical diseases.
Employing participatory design, we are working with site-based teams to adapt protocols that complement ICU workflow and respond to context while preserving the core components of OR-to-ICU handoff protocols, which are (1) a face-to-face team interaction at the patient bedside, and (2) use of a template or checklist to guide information exchange. We will identify factors likely to impact sustainment.
How do you envision the future of safety culture assessment and improvement in the perioperative environment?
EB: As the article mentions, there is no consensus on what dependent measures to include in perioperative safety culture studies. Thus, study investigators are encouraged to collect and analyze data about engaging in behaviors that prevent, respond to, or resolve safety issues, and related factors that support understanding their effects. They are encouraged to consider focusing on measures at the individual, team, and organizational level.
Was the original journal Anesthesiology Clinics? What is the significance of PubMed also making the article available?
EB: Yes. As this work is NIH funded, we follow NIH rules. The National Institutes of Health requires that investigators submit their final, peer-reviewed manuscripts to PubMed Central immediately upon acceptance for publication.
Would you like to include any other information?
EB: I was surprised to see that while safety culture addresses organizational factors, only one study that met our inclusion criteria included hospital administrators as participants. Considering the organizational level for patient safety initiatives, such roles are relevant in the participant cohorts. In order to address safety culture issues across the organization and group levels as well as to consider experience, the perioperative environment safety literature would benefit from studies that recruit, collection data, and report results from a broader participant base.
Information related to just culture (not playing the blame game but instead encouraging employees to report errors and vulnerabilities, and to hold organizations accountable for their systems and responses to employee behaviors) is important for understanding whether workers can and will engage with incident reporting and addressing errors and near misses or whether they will encounter or perceive they will encounter punitive behaviors.
Studies appear to be more likely to address the punitive side of the coin, but there is opportunity to investigate perceptions of offering praise, recognition, or other incentives to improve safety.
Find Dr. Bass's article on PubMed Central.