Study design | Authors/year | Culture target | Intervention | Subjects* | Results† | |
---|---|---|---|---|---|---|
Primary outcomes | Other outcomes | |||||
Controlled pre intervention /postintervention | Haugen et al 201321 | Improve safety climate perceptions | WHO Surgical Safety Checklist | Surgeons, anaesthesiologists, nurses, CRNAs, staff Preintervention: Intervention group N=146 Control group N=178 Postintervention: Intervention group N=140 Control group N=152 | Positive changes in the checklist intervention group for culture; ‘frequency of events reported’, ‘adequate staffing’ with regression coefficients of −0.25 (95% CI −0.47 to −0.07) and 0.21 (95% CI 0.07 to 0.35) | Positive but non-significant association with improved patient safety, teamwork within units, communication on error, hospital management promoting safety |
Weaver et al 201045 | Evaluate if team training effectiveness can improve teamwork behaviour and safety climate | Training curriculum based on TeamSTEPPS. Compared outcomes to untrained control group | Surgeons, anaesthesiologists, nurses, CRNAs, surgical techs, physician assistants Intervention group N=29 Control group N=26 | Significantly more pre-case briefings (p<0.001); significantly improved communication (use of handoffs, call-out, check-back) (p<0.05) | Positive but non-significant association with improved leadership and situation monitoring, feedback and communication about error, communication openness, overall patient safety scores | |
Uncontrolled preintervention/postintervention | Bleakley et al 201246 | Improve teamwork climate among OR staff | Multipronged, including educational programming, reporting system, a newsletter, open-access website | Surgeons, anaesthesiologists, nurses, staff Preintervention N=187 Postintervention N=164 | Significant improvement in teamwork climate (p=0.034; effect size not reported) | Positive but non-significant association with mean scores for other SAQ domains (job satisfaction, perception of management, working conditions, safety climate). ‘Stress recognition’ reduced significantly |
Armour Forse et al 201119 | Improve teamwork and communication in the OR | TeamSTEPPS | Surgeons, surgical residents, anaesthesiologists, anaesthesia residents, CRNAs, nurses, other staff; sample size not reported | Culture: | No change in team self-assessment; negative but non-significant association with PACU communication and teamwork | |
Improvement in communication and leadership based on survey at 9 months (p<0.05) | ||||||
Quality outcome: | ||||||
Increase in rates of antibiotics, 78% to 97% (p<0.005); VTE administration, 74% to 91% (p<0.05); beta-blockers, 19.7% to 100% (p<0.05); mortality, 2.7% to 1% (p<0.05); morbidity, 20.2% to 11.0% (p<0.05) | ||||||
Efficiency: | ||||||
Improvement in first case start (69% to 81%) and turnover (43 to 35.5 min, p<0.05) | ||||||
Arriaga et al 201120 | Develop and evaluate an intervention to reduce breakdowns in communication during inpatient surgical care, particularly between resident and attending surgeons | Multiple educational sessions, awareness campaigns, and reminder tools for expected communication standards | 211 critical events reviewed 1360 patients | Decrease in critical events not communicated to attending (33% to 2%, p<0.0001), rates of failure to notify attending surgeon of patient status on weekends (14.9% to 1.3%, p<0.0001), proportion of patients not visited by attending surgeon on weekends fell (61% to 33%, p=0.0002) | None reported | |
Carney et al 2011, ‘Changing perceptions’15 | Reduce the difference between providers at high- and medium- complexity facilities at the Veteran Health Administration for perceptions of organisational commitment to safety | MTT | 9616 attendees of learning sessions | Elimination of discrepancy in safety climate ratings between medium-complexity and high-complexity facilities | Postintervention, perceptions of individuals at medium-complexity facilities were more favourable than those at high-complexity facilities for “I would feel safe being treated here as a patient” (p=0.005) and “Medical errors are handled appropriately in this hospital” (p =0.023) | |
Carney et al 2011, ‘Improving perceptions’16 | Reduce disparities in perception of teamwork between surgeons and nurses | MTT | Physicians and nurses Preintervention N=2074 Postintervention N=790 | Significant improvement in all six teamwork climate items among physicians; nurses significant improvement in 5/6 items | Nurses do not perceive difference in ‘nurse input well-received’ | |
Pettker et al 201122 | Improve patient safety and safety culture | Outside expert review, protocol standardisation, creation of a patient safety nurse position and patient safety committee | Obstetricians, nurse midwives, paediatricians, neonatologists, anaesthesiologists, residents, nurses, surgical technicians, aides, and social workers. Median N=191 responding to each survey (range 183–198) | Improvements in the proportion of staff members with favourable perceptions of teamwork culture (39% in 2004 to 63% in 2009, p<0.0001), safety culture (33% to 63%, p<0.0001), job satisfaction (39% to 53%, p=0.009), and management (10% to 37%, p<0.0001) | Positive but non-significant association with percentage of providers’ perception of stress recognition | |
Wolf et al 201017 | Improve teamwork and patient safety in OR | MTT | 4863 MTT debriefings | Culture: | Positive but non-significant association with teamwork climate, safety climate, job satisfaction, stress recognition | |
Improvement in perceptions of management (p=0.003) and working conditions (p=0.004) | ||||||
Efficiency: | ||||||
Decrease in operating room delays (23% to 10%, p<0.0001), equipment availability problems (14% to 4%, p<0.001), equipment malfunction problems (7% to 2.7%, p=0.019), reported handoff issues (5.4% to 0.3%, p<0.0001) | ||||||
Pettker et al 200938 | Improve patient safety and safety culture | Outside expert review, protocol standardisation, creation of a patient safety nurse position and patient safety committee | Obstetricians, midwives, Ob/Gyn residents, anaesthesiologists, nurses, staff | Culture: | Positive but non-significant association with certain individual complications, including third-degree and fourth-degree lacerations and shoulder dystocia | |
Duplication of results from Pettker et al22 | ||||||
Quality outcome: | ||||||
Reduction in the Adverse Outcome Index (linear regression, r2=0.50; p<0.01) |
*N provided when available.
†Effect size and p values provided when available.
CRNA, Certified Registered Nurse Anaesthetist; MTT, Medical Team Training; PACU, postanaesthesia care unit; PICUOR, operating room; SAQ, Safety Attitudes Questionnaire; TeamSTEPPS, Team Strategies to Enhance Performance and Patient Safety; VTE, venous thromboembolism.