Improving safety culture results in Rhode Island ICUs:Lessons learned from the development of action-oriented plans
The Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient safety and clinical outcomes in adult ICUs through a unit-based patient safety program and evidenced-based practices. Few studies have shown how to draw on a strong safety culture to improve clinical outcomes. A study was conducted to (1) examine the impact of a Safety Attitudes Questionnaire Action Plan (SAQAP) on the 2008 Safety Attitudes Questionnaire (SAQ) and (2) determine the impact of an SAQAP on ICU central line-associated blood stream infections (CLABSIs) and ventilator-associated pneumonia (VAP) rates. The SAQ was administered at 23 ICUs in 11 hospitals in fall 2007 and 2008. Units were surveyed as to whether they completed an SAQAP on the basis of 2007 SAQ results. Annual rates of infection were submitted as unadjusted monthly CLABSI infections per 1,000 line days and VAP infections per 1,000 ventilator days for 2007 and 2008. SAQAPs were completed on 9 (39%) of the 23 units. Units that developed SAQAPs demonstrated higher improvement rates in all domains of the SAQ except working conditions. Improvements were close to statistical significance for teamwork climate (+18.4% in SAQAP units versus -6.4%, p = .07) and job satisfaction (+25.9% increase in SAQAP units versus +7.3%, p = .07). Units with SAQAPs decreased the CLABSI rates by 10.2% in 2008 compared with 2007, while those without SAQAP had a 2.2% decrease in rates (p = .59). Similarly, VAP rates decreased by 15.2% in SAQAP units, while VAP rates increased by 4.8% in units without SAQAP (p = .39). Teams that developed SAQAPs improved their unit culture and clinical outcomes. An active, targeted intervention in culture can translate into improved outcomes for patients.