Title | Safety climate, safety climate strength, and length of stay in the NICU. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Tawfik DS, Thomas EJ, Vogus TJ, Liu JB, Sharek PJ, Nisbet CC, Lee HC, J Sexton B, Profit J |
Journal | BMC Health Serv Res |
Volume | 19 |
Issue | 1 |
Pagination | 738 |
Date Published | 2019 Oct 22 |
ISSN | 1472-6963 |
Keywords | Female, Humans, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Length of Stay, Male, Organizational Culture, Patient Safety |
Abstract | BACKGROUND: Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs). METHODS: Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU's respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality. RESULTS: NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes. CONCLUSIONS: Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals. |
DOI | 10.1186/s12913-019-4592-1 |
Alternate Journal | BMC Health Serv Res |
PubMed ID | 31640679 |
PubMed Central ID | PMC6805564 |
Grant List | R01 HD084679-01 / / Eunice Kennedy Shriver National Institute of Child Health and Human Development / R01 HD084679-01 / / Eunice Kennedy Shriver National Institute of Child Health and Human Development / K24 HD053771-01 / / Eunice Kennedy Shriver National Institute of Child Health and Human Development / n/a / / Jackson Vaughan Critical Care Research Fund / |