Intensive care unit safety culture and outcomes: A US multicenter study

David T. Huang, Gilles Clermont, Lan Kong, Lisa A. Weissfeld, J. Bryan Sexton, Kathy M. Rowan, Derek C. Angus

Research output: Contribution to journalArticle

160 Citations (Scopus)

Abstract

Objective: Safety culture may influence patient outcomes, but evidence is limited. We sought to determine if intensive care unit (ICU) safety culture is independently associated with outcomes. Design: Cohort study combining safety culture survey data with the Project IMPACT Critical Care Medicine (PICCM) clinical database. Setting: Thirty ICUs participating in the PICCM database. Participants: A total of 65 978 patients admitted January 2001-March 2005. Interventions: None. Main outcome measures: Hospital mortality and length of stay (LOS). Methods. From December 2003 to April 2004, we surveyed study ICUs using the Safety Attitudes Questionnaire-ICU version, a validated instrument that assesses safety culture across six factors. We calculated factor mean and percent-positive scores (% respondents with mean score ≥75 on a 0-100 scale) for each ICU, and generated case-mix adjusted, patient-level, ICU-clustered regression analyses to determine the independent association of safety culture and outcome. Results: We achieved a 47.9% response (2103 of 4373 ICU personnel). Culture scores were mostly low to moderate and varied across ICUs (range: 13-88, percent-positive scores). After adjustment for patient, hospital and ICU characteristics, for every 10% decrease in ICU perceptions of management percent-positive score, the odds ratio for hospital mortality was 1.24 (95% CI: 1.07-1.44; P = 0.005). For every 10% decrease in ICU safety climate percent-positive score, LOS increased 15% (95% CI: 1230%; P = 0.03). Sensitivity analyses for non-response bias consistently associated safety climate with outcome, but also yielded some counterintuitive results. Conclusion. In a multicenter study conducted in the USA, perceptions of management and safety climate were moderately associated with outcomes. Future work should further develop methods of assessing safety culture and association with outcomes.

Original languageEnglish (US)
Article numbermzq017
Pages (from-to)151-161
Number of pages11
JournalInternational Journal for Quality in Health Care
Volume22
Issue number3
DOIs
StatePublished - Apr 9 2010

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Safety Management
Multicenter Studies
Intensive Care Units
Climate
Critical Care
Hospital Mortality
Safety
Length of Stay
Databases
Diagnosis-Related Groups
Clinical Medicine
Patient Care
Cohort Studies
Odds Ratio
Regression Analysis
Medicine
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Huang, D. T., Clermont, G., Kong, L., Weissfeld, L. A., Sexton, J. B., Rowan, K. M., & Angus, D. C. (2010). Intensive care unit safety culture and outcomes: A US multicenter study. International Journal for Quality in Health Care, 22(3), 151-161. [mzq017]. https://doi.org/10.1093/intqhc/mzq017
Huang, David T. ; Clermont, Gilles ; Kong, Lan ; Weissfeld, Lisa A. ; Sexton, J. Bryan ; Rowan, Kathy M. ; Angus, Derek C. / Intensive care unit safety culture and outcomes : A US multicenter study. In: International Journal for Quality in Health Care. 2010 ; Vol. 22, No. 3. pp. 151-161.
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Huang, DT, Clermont, G, Kong, L, Weissfeld, LA, Sexton, JB, Rowan, KM & Angus, DC 2010, 'Intensive care unit safety culture and outcomes: A US multicenter study', International Journal for Quality in Health Care, vol. 22, no. 3, mzq017, pp. 151-161. https://doi.org/10.1093/intqhc/mzq017

Intensive care unit safety culture and outcomes : A US multicenter study. / Huang, David T.; Clermont, Gilles; Kong, Lan; Weissfeld, Lisa A.; Sexton, J. Bryan; Rowan, Kathy M.; Angus, Derek C.

In: International Journal for Quality in Health Care, Vol. 22, No. 3, mzq017, 09.04.2010, p. 151-161.

Research output: Contribution to journalArticle

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T1 - Intensive care unit safety culture and outcomes

T2 - A US multicenter study

AU - Huang, David T.

AU - Clermont, Gilles

AU - Kong, Lan

AU - Weissfeld, Lisa A.

AU - Sexton, J. Bryan

AU - Rowan, Kathy M.

AU - Angus, Derek C.

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