The Effect of a Freely Available Flipped Classroom Course on Health Care Worker Patient Safety Culture: A Prospective Controlled Study

Effect of patient safety education interventions on patient safety culture of health care professionals: Systematic review and meta-analysis

AIM

To synthesize and evaluate the cumulative effect of patient safety education intervention for health care professional staff in the hospital setting on their patient safety culture.

BACKGROUND

Patient security Culture is an important factor in ensuring patient safety and it is recommended as one of the pillars of preventive strategies in the healthcare system.

DESIGN

Systematic review and meta-analysis were prospectively registered with PROSPERO.

METHODS

This review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, Ovid, CINAHL, Cochran Library, Web of Science and randomized control trial registration databases from January 1999 to February 2021. Studies on patient safety culture intervention were included. We assessed research quality using the jadad scale for RCTs and the Methodological Index for Non-Randomized Studies RESULTS: Sixteen studies with a total of 3438 participants in the intervention group and 3121 in the control group were included in the final analysis. The random-effect meta-analysis shows significant heterogeneity among studies that assessed patient safety culture as a mean percentage of positive responses or as a mean score of 1-5 scale. (I² = 91% and 77%, respectively). Also, there was a significant difference between experimental and control group in the overall pooled effect of patient safety culture in the studies that used the mean percentage of positive response [Mean Difference = 5.24, 95% confidence interval (1.32, 9.16, Z = 2.62; P = 0.009] or the mean score [Mean Difference = 0.08, 95% confidence interval (0.01, 0.15), Z = 2.26; P = 0.02]. The difference was no longer significant in the mean score studies after excluding the studies with low-quality scores. Subgroup analysis showed no change in the pooled effect of the studies with quasi-experimental [Mean Difference = 7.84, 95% confidence interval (2.35, 13.33); Z = 2.80; p = 0.005) or before-after design [MD= 0.11, 95% confidence interval (0.07, 0.14); Z = 5.74; p = 0.000]. However, the patient safety education intervention remained effective after one year of follow-up.

CONCLUSIONS

Our review Provides empirical evidence on current efforts in patient safety education to improve a healthcare professional-patient safety culture. The Patient safety education program could improve the patient safety culture of health care professionals.

Safety culture in French nursing homes: A randomised controlled study to evaluate the effectiveness of a risk management intervention associated with care

BACKGROUND

French Nursing Homes (NHs) are in the early stages of implementing their Risk Management (RM) approach. A regional structure, which was mandated to provide independent support in RM, designed a training package.

OBJECTIVE

To study the impact of the RM training package on safety culture (SC) in NHs and drivers for improvement in SC scores.

METHOD AND ANALYSIS

This randomised controlled study targeted French NHs. Inclusion criteria were voluntary participation, no external support provided on the topic of adverse incidents upstream of the project, and the commitment of top management to its implementation. The 61 NHs were randomly allocated to one of two groups: the first benefited from a training package; support was given to the second after the impact measurement. Seven dimensions of SC were measured, at an 18-month interval, using the validated Nursing Home Survey on Patient Safety Culture questionnaire (22 items), which was administered to all of the professionals working in NHs. Eleven variables were captured, relating to the structural profile of the NH, the choices of top management in terms of healthcare safety, and the implementation of the system. Further modelling identified predictive factors for changes in SC scores.

RESULTS

95% of NHs completed both rounds of the questionnaire. The dimension Feedback and communication about incidents (SC = 85.4% before the intervention) significantly improved (+2.8%; p = 0.044). Improvement in the dimension Overall perceptions of resident safety-organizational learning was close to significant (+3.1%; p = 0.075). Drivers for improvement in scores were a pre-existing quality improvement approach, and a steering group that showed RM leadership.

CONCLUSIONS

The system appears to have improved several dimensions of SC. Our findings are all the more important given the current crisis in the healthcare sector.

TRIAL REGISTRATION

Retrospectively registered as NCT02908373 (September 21, 2016).

Study on the Reporting Quality of Randomized Controlled Trials of Flipped Classroom in Medical Education

BACKGROUND

With the deepening of medical education reform, the flipped classroom has become a commonly used teaching method. Many randomized controlled trials (RCTs) have shown that flipped classroom combined with problem-based learning (PBL) improves many students' abilities. It remains unclear whether the design and reports of these RCTs comply with specifications. The aim of this study was to provide a systematic assessment of the quality of RCTs investigating the effectiveness of flipped classroom teaching in medical education.

METHOD

Two investigators searched PUBMED and EMBASE and analyzed 15 filtered RCTs addressing flipped classroom in medical education, published between January 1, 2016 and December 31, 2021. The overall reporting quality was assessed using the overall quality score (OQS) according to the 2010 CONSORT statement.

RESULTS

The search revealed 15 RCTs closely related to flipped classrooms. After analysis, it appeared that least half of them made no mention of half of the OQS items in the CONSORT 2010 statement. Since the flipped classroom is an emerging teaching method, all the retrieved articles were published after 2016. Furthermore, a number of issues that we considered very important were not adequately addressed in the RCT reports.

DISCUSSION

Although the CONSORT 2010 statement was issued 12 years ago, the quality and content of many RCTs are not satisfactory. Our findings suggest that authors need to make more effort to meet the CONSORT statement requirements. This article is protected by copyright. All rights reserved.

The effect of situation, background, assessment, recommendation-based safety program on patient safety culture in intensive care unit nurses

BACKGROUND

Patient safety culture is an integral part of patient care standards and a prerequisite for safe care. SBAR is an acronym for Situation, Background, Assessment, Recommendation; this communication model has gained popularity in health-care settings, especially among professions such as nursing. However, there is little evidence that nursing professional education can enhance patient safety culture. The aim of this study was to investigate the effect of a SBAR-based training program on patient safety culture in intensive care unit (ICU) nurses.

MATERIALS AND METHODS

The quasi-experimental study was carried out in 2018-2019 at areas covered by Shahrekord University of Medical Sciences, Iran. This study was performed on 60 nurses working in ICU. The participants were randomly assigned to two experimental and control groups of 30 each. For the experimental group, five workshop sessions of SBAR-based program were held. For the control group, the patient delivery process was performed according to the ward routine. Data were collected using patient safety culture questionnaires before and 1 month after the intervention, and were analyzed using descriptive and analytical tests such as paired t-test, independent t-test, and Chi-square test by SPSS 22.

RESULTS

The mean score of safety culture was 31 ± 23.5 and 55.2 ± 28.6 in frequency of reporting events, 32.8 ± 17.8 and 54.3 ± 19 in overall perception of patient safety, 23 ± 20.1 and 52.9 ± 26 in communication channel openness, and 35.2 ± 19.8 and 52.4 ± 18.8 in information exchange and conveyance before and after training intervention, respectively, so that they improved from poor level to neutral-moderate level. There was no strength in any dimensions of safety culture; however, the implementation of the SBAR-based program was significantly associated with patient safety culture (P < 0.001).

CONCLUSIONS

Improving patient safety culture requires attention to patient safety models such as SBAR approach that provides an appropriate and reliable structure for quality improvement. SBAR-based program training is effective in promoting patient safety culture; therefore, it is recommended that managers use this technique to promote patient safety culture.

Application of comprehensive u nit-based safety program model in the inter-hospital transfer of patients with critical diseases: a retrospective controlled study

Background

To explore the effect of applying a comprehensive unit-based safety program (CUSP) in the intrahospital transfer of patients with critical diseases.

Methods

A total of 426 critically ill patients in the first affiliated Hospital of Anhui Medical University from August 2018 to February 2019 were divided into two groups according to the time of admission. Overall, 202 patients in the control group were treated with the routine transfer method, and 224 patients in the observational group were treated with the transfer method based on the CUSP model. The safety culture assessment data of medical staff, the occurrence rate of adverse events and related causes, the time of transfer, and the satisfaction of patients’ relatives to the transfer process were compared before and after implementation of the transfer model between the two groups.

Results

Before and after the implementation of the CUSP mode transfer program, there were significant differences in the scores of all dimensions of the safety culture assessment of medical staff (P < 0.05), and the occurrence rate of adverse events and the causes in the observational group were significantly lower than those in the control group (disease-related, staff-related, equipment-related, environment-related) (P < 0.05). The transfer time for Computed Tomography (CT), Magnetic Resonance Imaging (MRI), operating room, and the interventional room was significantly shorter in the observational group than that in the control group (P < 0.05), while the satisfaction of relatives to the transfer process was significantly higher than those in the control group (P < 0.05).

Conclusion

The implementation of CUSP model for the intrahospital transfer of critically ill patients can significantly shorten the in-hospital transfer time, improve the attitude of medical staff towards safety, reduce the occurrence rate of adverse events, and improve the satisfaction of patients’ relatives to the transfer process.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06650-7.

The effect of education around ethical principles on nurses' perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study

Background & objectives

Patient safety is a crucial factor in the provision of quality healthcare and is therefore a global health concern. It is an area in which ethical concerns and high-quality clinical practice are inextricably linked. This study investigates the effect of education around ethical principles on nurses’ perception of patient safety in a psychiatric unit.

Materials & methods

This pre- and post-test descriptive study was conducted in a mental health inpatient unit in a hospital in Tehran, capital of Iran, in 2018. A total of 33 nurses, selected by census sampling, participated in the study. Data was collected using a demographics questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC), and was analyzed with SPSS21.

Results

The mean score of patient safety was 116.85 ± 9.98 before the educational intervention, 143.58 ± 7.21 immediately after intervention, and 153.12 ± 9.47 1 month after intervention. The rate of error report by most participants over the past 12 months was 3–5 and 6–10 events before intervention, and 6–10 events immediately after and 1 month after intervention. Also, 42.4% of the participants assessed patient safety after intervention as very good and 36.4% assessed it as acceptable and very good 1 month after intervention whereas most of the participants (45.5%) assessed patient safety as acceptable before intervention.

Conclusion

Education on ethical principles exerts a positive effect on nurses’ perception of patient safety culture. Thus, it is recommended as an effective method of promoting nurses’ perception of this variable. In this way, healthcare quality and enhanced patient safety can be achieved.

Interventions to improve team effectiveness within health care: a systematic review of the past decade

BACKGROUND

A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design.

OBJECTIVES

To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research.

METHODS

Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence.

RESULTS

Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements.

CONCLUSION

Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.

Safety culture in intensive care internationally and in Australia: A narrative review of the literature

OBJECTIVE

Assessment of safety culture in health care is of particular relevance in the complex intensive care setting, where the effects of human error can have catastrophic consequences. The aim of this review was to examine the literature on safety culture in intensive care units (ICUs) and specifically, to explore the state of knowledge regarding safety culture in the context of Australian ICUs.

METHODS

A search was conducted of key databases for studies published in English between January 2008 and December 2017 using terms 'safety culture', 'safety climate', 'safety attitude', 'intensive care', 'ICU' and 'critical care'. Studies were included if they presented original research, utilised the teamwork and safety climate factors of a quantitative survey tool to assess safety culture, the sample population included participants working in an adult intensive care, and the findings were reported in the context of intensive care.

RESULTS

Of the 36 studies identified, two were conducted in Australia. The studies demonstrate a rapid expansion in safety culture assessment globally. Three levels of safety culture application in intensive care were identified, including safety culture assessment, effect of an intervention on safety culture, and evaluation of the association between safety culture and structural, process and outcomes measures. The use of targeted safety culture domains is emerging. Common findings included variation in perceptions of safety culture between ICUs, unit and hospital management, and professional groups.

CONCLUSION

Though the assessment of safety culture in ICUs has been an area of prolific research internationally over the past ten years, the Australian context is limited and could be advanced through further research, including the effect on safety culture of interventions, and to establish the association between safety culture and patient safety outcomes. Longitudinal studies to demonstrate sustained intervention effects on safety culture should be considered.