Assessing patient safety culture and its associated factors in 12 emergencies across Tunisia

Abstract

Background Although the emergency departments (EDs) are the front line of the public health system, they are considered high-risk environments because of the shocking frequency of adverse events, within. Developing safety culture among EDs professionals, as a strategic focus, remains a priority. The purpose of this study is to measure safety culture in EDs and to determine its associated factors. Methods This is a cross-sectional and multicenter study, conducted among professionals from all the EDs of public and private healthcare institutions in central Tunisia. It was conducted from June to September 2017. The instrument tool used was the self-administered Hospital Survey On Patient Safety Culture questionnaire translated and validated by the CCECQA. Data entry and analysis were performed using SPSS 20.0 and Epi info 6. Also, ethical considerations were taken into account. Results In total, the study included 442 participants from 12 ED, with a participation rate of 80.35%. All the ten dimensions of safety culture were all to be improved. As for 'teamwork within units', it scored the highest with 46%, however, the lowest scores were attributed to 'the frequency of reported adverse events' (19.6%) followed by 'the non-punitive response to error' (19.8%). Private EDs have shown significantly higher scores regarding nine safety culture dimensions. Also, the size of the hospital was significantly associated with all dimensions of the safety culture. Conclusions This study has shown that the level of safety culture needs to be improved in public and private EDs and also underlines the importance of developing the safety culture and the implementation of safety and quality management systems. Key messages Patient safety culture is to be improved in Tunisian emergencies, although it is significantly more developed in private settings. A punitive culture still reigns in Tunisian healthcare context.

Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study

“…56 However, most previous research focussed on improving safety culture in inpatient care. Indeed, developing patient safety culture among EDs professionals, remains a priority that needs to be strategically focuses on 19 The Delphi method is a widely used and well-recognised tool in harnessing expert opinions, finding expert solutions to a particular problem. 46 It has been used in several fields such as program planning, requirements assessment, policy determination, and resource use 51 and is an effective technique to achieve and measure group consensus in healthcare evaluation.…”

“…16 However, EDs are contemplated as high-risk environment. [17][18][19] Dynamic nature of ED comprises offering ser-treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale.…”

“…To date, there is not much known about creating and maintaining safety culture in EDs. Evidently, this is an important area to investigate considering that EDs are the 'front-line' of hospital care 19,27 and patients in the ED are particularly susceptible to medical errors 28 and adverse events. 19 To our knowledge, this is the first study that utilised modified Delphi design to explore strategies to promote patient safety culture in health care settings.…”

“…Evidently, this is an important area to investigate considering that EDs are the 'front-line' of hospital care 19,27 and patients in the ED are particularly susceptible to medical errors 28 and adverse events. 19 To our knowledge, this is the first study that utilised modified Delphi design to explore strategies to promote patient safety culture in health care settings. The primary aim of this study was to identify evidence-based interventions and strategies for improving safety culture in the ED.…”