Background. Adverse events (AEs) affect 10% of in-hospital patients, causing increased costs, injuries, disability and mortality. Patient safety culture (PSC) is an indicator of quality in healthcare services and is thus perceived as a proxy for the quality of care. Previous studies show variation in the association between PSC scores and AE rates. The main objective of this scoping review is to summarise the evidence on the association between PSC scores and AE rates in healthcare services. In addition, map the characteristics and the applied research methodology in the included studies, and study the strengths and limitations of the evidence. Methods. We applied a scoping review methodology to answer the broad research questions of this study, following the PRISMA-ScR checklist. A systematic search in seven databases was conducted in January 2022. The records were screened independently against eligibility criteria using Rayyan software, and the extracted data were collated in a charting form. Descriptive representations and tables display the systematic mapping of the literature. Results. We included 34 out of 1,743 screened articles. The mapping demonstrated a statistical association in 76% of the studies, where increased PSC scores were associated with reduced AE rates. Most of the studies had a multicentre design and were conducted in-hospital in high-income countries. The methodological approaches to measuring the association varied, including missing reports on the tools` validation and participants, different medical specialties, and work unit level of measurements. In addition, the review identified a lack of eligible studies for meta-analysis and synthesis and demonstrated a need for an in-depth understanding of the association, including context complexity. Conclusions. We found that the vast majority of studies report reduced AE rates when PSC scores increase. This review demonstrates a lack of studies from primary care and low- and- middle-income countries. There is a discrepancy in utilised concepts and methodology, hence there is a need for a broader understanding of the concepts and the contextual factors, and more uniform methodology. Longitudinal prospective studies with higher quality can enhance efforts to improve patient safety.
Commentaire du Dr Marius Laurent (PAQS)
- La revue porte sur les articles en anglais ou en langues scandinaves qui étudient simultanément les changements en culture de sécurité et les événements indésirables. Elle confirme la très grande hétérogénéité de ces études, tant sur leurs sujets (service ou hôpital ?) que sur les méthodes d’évaluation de la culture de sécurité (outil HSOPS pour 38% ou SAQ pour 29%, mais aussi des fragments de ces questionnaires ou d’autres méthodes) et des événements indésirables (surtout des registres ou des revues de dossiers). La méta-analyse n’est pas possible. Dans trois quarts des articles, le nombre d’EI diminue si la culture s’améliore, dans le quart restant, cet effet n’apparaît pas, voire s’inverse. Comme on peut s’y attendre, les auteurs consacrent beaucoup de temps à explorer tout ce qui rend les mesures de culture et d’événements indésirables peu fiables, en particulier des taux de réponse souvent peu satisfaisants dans les questionnaires de culture, et les doutes habituels sur l’exhaustivité des registres ou des dossiers hospitaliers pour la détection des EI. Ils abordent également la difficulté de définir de bonnes fenêtres temporelles pour évaluer la culture et son effet éventuel sur les EI. Peut-on espérer que l’évolution récente des outils (nouvelle version de l’HSOPS en particulier) permettra de mieux décrire ce qui caractérise la culture de sécurité ? Je crains qu’encore longtemps, il faille se contenter du fait « qu’une majorité des études » est en faveur de l’association (espérée).
Vikan M, Haugen AS, Bjornnes AK, Valeberg BT, Deilkas ECT, Danielsen SO.The association between patient safety culture and adverse events – a scoping review. BMC Health Serv Res 2023;23(1):300. Doi : 10.1111/anae.15920.