Evidence is lacking for patient safety strategies

By Sarah Guy, MedWire Reporter

Evidence for the efficacy of in-hospital strategies to improve patient safety culture are lacking, show the results of a systematic review.

The findings revealed some strong evidence that walk-rounds and multi-faceted unit-based programs improve patient safety cultures - as measured using patient safety climate scores, say the researchers.

However, the team believes that the complexity of the construct known as "culture" and a lack of understanding of certain elements and their interdependency are the reasons for the limited evidence identified by their review.

"Organisations considering the implementation of potentially costly and resource-intensive strategies should evaluate programmes within a robust study design," suggest Renata Teresa Morello (Monash University, Melbourne, Victoria, Australia) and colleagues in BMJ Quality and Safety.

Of the 21 studies included in the review, 11 tested strategies were reported, including leadership walk-rounds, structured educational programs, team-based strategies, simulation-based training programs, multi-faceted unit-based programs, and multi-component organizational interventions.

One study showed a significant positive effect on patient safety climate (which was measured using validated surveys such as the Safety Attitudes Questionnaire and the Safety Climate Survey), when nurses participated in walk-rounds, compared with a control group.

The team strategy tool TeamSTEPPS showed a significant positive trend toward improvement of patient safety climate scores over time in both the intervention and control group in one study, and in that study and another the strategy showed improvements in team behaviors and the structure of team meetings.

A controlled before and after study evaluated the effectiveness of a structured multi-faceted framework for assessing, identifying, reporting, and improving patient safety concerns, which had a significant positive effect on patient safety climate scores.

This strategy is "specifically designed to improve unit culture," write Morello et al.

Simulation-based training programs and multi-component organizational interventions showed no effect and a negligible effect on patient safety climate scores, respectively, while certain elements of structured educational programs - like a nurse clinical leader educational program - showed some positive effect on certain elements of the patient safety climate survey.

Six studies qualitatively examined implementation of their strategies, and found their data "highlighted gaps between management level engagement, ward practice and clinical staff engagement and practice change," remark Morello and co-authors.

"Even strategies with a strong evidence base will fail in an organization when they have been poorly implemented or supportive," the team concludes.

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