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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
57th Annual Meeting Abstracts


Poster 20

Abstract Title

Integral Components of Patient Safety Climate among Orthopaedic Surgery Residents

 

Author Block

John Kadzielski, MD, Frank McCormick, MD, David Zurakowski PhD, James H. Herndon, MD, MBA

Partners Health System,Boston, MA

 

Abstract Body

BACKGROUND: Safety climate is a cross-sectional snapshot of an organizationís overall safety culture. Safety culture is a critical component of what allows highly reliable organizations (HROs) to have a systematic approach to safety and produce consistent outcomes despite intrinsic hazards. The purpose of this study is to identify the baseline safety climate and track its trends in orthopaedic surgical training.

METHODS: Residents of a large orthopaedic surgery program who operate at 6 different medical centers and 2 surgical centers were invited to complete a modified version of the Patient Safety Cultures in Healthcare Organizations (PSCHO) Questionnaire. Post-graduate year (PGY)-2 through PGY-5 orthopaedic surgery residents completed a questionnaire at 4 time points: 2004, 2005, 2008 and 2009.

RESULTS: Over the 4 time points, 169 total resident responses were collected. The overall rate of problematic responses was 12.6% for residents. When analyzed according to calendar year, there were significant decreases in safety climate in the organization (P < 0.001), communication (P < 0.017), management (P < 0.001), reporting (P < 0.001), and overall safety climate scores (P < 0.001). Two major threats to establishing and maintaining a positive safety climate were identifiedómanagementís failure to restrict physicians under high stress and failure to react well to unexpected changes.

CONCLUSIONS: This research has identified a lack of safety climate that has affected at least 10 graduating classes of orthopaedic surgery residents. When compared to naval aviators, residents reported more than twice the amount of problematic responses.

TABLE 1

 

Question

 

Problematic Response Rate

 

Neutral

Positive Safety Climate Response Rate

1

7.7%

4.7%

87.6%

2

16.6%

27.8%

55.6%

3

16.0%

11.8%

72.2%

4

10.7%

12.4%

76.9%

5

42.0%

45.6%

12.4%

6

39.1%

37.9%

23.1%

7

17.8%

17.2%

65.1%

8

17.2%

21.9%

60.9%

9

11.8%

29.0%

59.2%

10

14.8%

25.4%

59.8%

11

7.1%

11.8%

81.1%

12

12.4%

21.9%

65.7%

13

13.0%

26.6%

60.4%

14

8.3%

14.2%

77.5%

15

7.1%

23.1%

69.8%

16

14.2%

22.5%

63.3%

17

0.6%

10.1%

89.3%

18

2.4%

13.0%

84.6%

19

8.9%

39.1%

52.1%

20

3.6%

27.8%

68.6%

21

13.6%

18.3%

68.0%

22

6.5%

21.9%

71.6%

23

9.5%

21.9%

68.6%

24

1.2%

6.5%

92.3%

 

TABLE 2

Year Collected

Organization **

Communication*

Management**

Reporting**

Point-of-Care

Total Score**

2004

8.51

1.44

4.72

0.82

0.97

16.46

2005

8.52

1.52

3.74

0.55

0.98

15.31

2008

5.05

0.77

0.95

0.08

0.85

7.70

2009

7.02

1.17

2.60

0.38

0.85

12.02

*Denotes statistical significance P < 0.05.

**Indicates statistical significance P < 0.001.

 

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