Questionnaire for assessing patient safety culture in emergency services: an integrative review

Torrente, Gisele; Barbosa, Sayonara de Fátima Faria

doi:10.1590/0034-7167-2019-0693

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (2) • 2021 • https://doi.org/10.1590/0034-7167-2019-0693 copy

Questionnaire for assessing patient safety culture in emergency services: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify the instruments used to assess patient safety culture in emergency settings.

Method:

an integrative literature review conducted from 2000 to 2018.

Results:

13 instruments were identified to assess patient safety culture in hospital and pre-hospital emergencies, comprising 12 to 50 questions, grouped from three to 12 dimensions, with dimensions related to teamwork, support, and management actions for patient safety and for continuous process improvement and continuing education. The Emergency Medical Service Safety Attitude Questionnaire, which is exclusive for pre-hospital care, stands out.

Conclusions:

the choice and the best decision regarding the instrument are linked to the objectives, the environment and the population to be investigated, as well as the instrument’s reliability.

Descriptors:
Safety Management; Organizational Culture; Patient Safety; Process Assessment (Health Care); Emergency Medical Services

Instruments		No. Search/ Country/Year	No. of questions	No. of dimensions	Setting
1	HSOPSC⁽⁹9 Alquwez N, Cruz JP, Almoghairi AM, Al-Otaibi RS, Almutairi KO, Alicante JG, et al. Nurses' perceptions of patient safety culture in three hospitals in Saudi Arabia. J Nurs Scholarship. 2018;50(4):422-31. https://doi.org/10.1111/jnu.12394 https://doi.org/10.1111/jnu.12394... 10 Burström L, Letterstål A, Engström ML, Berglund A, Enlund M. The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study. BMC Health Serv Res. 2014;14(1):296. https://doi.org/10.1186/1472-6963-14-296 https://doi.org/10.1186/1472-6963-14-296... 11 Cho SM, Choi J. Patient safety culture associated with patient safety competencies among registered nurses. J Nurs Scholarship. 2018;50(5):549-57. https://doi.org/10.1111/jnu.12413 https://doi.org/10.1111/jnu.12413... 12 Jang HE, Song Y, Kang HY. Nurses' perception of patient safety culture and safety control in patient safety management activities. J Korean Acad Nurs Adm. 2017;23(4):450. https://doi.org/10.11111/jkana.2017.23.4.450 https://doi.org/10.11111/jkana.2017.23.4... 13 Jones F, Podila P, Powers C. Creating a culture of safety in the emergency department: the value of teamwork training. J Nurs Adm. 2013;43(4):194-200. https://doi.org/10.1097/NNA.0b013e31828958cd https://doi.org/10.1097/NNA.0b013e318289... ^-¹⁴14 Tourani S, Hassani M, Ayoubian A, Habibi M, Zaboli R. Analyzing and prioritizing the dimensions of patient safety culture in emergency wards using the TOPSIS Technique. Glob J Health Sci. 2015;7(4):143-50. https://doi.org/10.5539/gjhs.v7n4p143 https://doi.org/10.5539/gjhs.v7n4p143... ⁾	Portugal (2011), Korea (2017), South Korea (2018), Saudi Arabia (2018), Sweden (2013)	42	12	α
1	HSOPSC⁽¹⁴14 Tourani S, Hassani M, Ayoubian A, Habibi M, Zaboli R. Analyzing and prioritizing the dimensions of patient safety culture in emergency wards using the TOPSIS Technique. Glob J Health Sci. 2015;7(4):143-50. https://doi.org/10.5539/gjhs.v7n4p143 https://doi.org/10.5539/gjhs.v7n4p143... ⁾	Iran (2014)	42	12	β
2	SAQ⁽¹⁵15 Rigobello MCG, Carvalho REFL, Guerreiro JM, Motta APG, Atila E, Gimenes FRE. The perception of the patient safety climate by professionals of the emergency department. Int Emerg Nurs. 2017;33:1-6. https://doi.org/10.1016/j.ienj.2017.03.003 https://doi.org/10.1016/j.ienj.2017.03.0... ⁾	Brazil (2016)	41	6	α
3	AACN HWEAT and HSOPSC⁽¹⁶16 Connor JA, Ziniel SI, Porter C, Doherty D, Moonan M, Dwyer P, et al. Interprofessional use and validation of the AACN Healthy Work Environment Assessment Tool. Am J Crit Care. 2018;27(5):363-71. https://doi.org/10.4037/ajcc2018179 https://doi.org/10.4037/ajcc2018179... ⁾	USA (2018)	20	6	α
4	RPPE⁽¹⁷17 Lambrou P, Papastavrou E, Merkouris A, Middleton N. Professional environment and patient safety in emergency departments. Int Emerg Nurs. 2015;23(2):150-5. https://doi.org/10.1016/j.ienj.2014.07.009 https://doi.org/10.1016/j.ienj.2014.07.0... ⁾	Cyprus (2014)	39	8	α
5	PCQ-F⁽¹⁸18 Lindahl J, Elmqvist C, Thulesius H, Edvardsson D. Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire: family version. Scand J Caring Sci. 2015;29(4):859-64. https://doi.org/10.1111/scs.12198 https://doi.org/10.1111/scs.12198... ⁾	Sweden (2015)	17	3	δ
6	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association⁽¹⁹19 McNeill MM, Pierce P, Dukes S, Bridges EJ. En route care patient safety: thoughts from the field. Mil Med. 2014;179(8 Suppl):11-8. https://doi.org/10.7205/MILMED-D-13-00522 https://doi.org/10.7205/MILMED-D-13-0052... ⁾	USA (2014)	15	4	Ω
7	ED Survey Colorado⁽²⁰20 Camargo Jr CA, Tsai CL, Sullivan AF, Cleary PD, Gordon JA, Guadagnoli E, et al. Safety climate and medical errors in 62 US emergency departments. Ann Emerg Med. 2012;60(5):555-63.e20. https://doi.org/10.1016/j.annemergmed.2012.02.018 https://doi.org/10.1016/j.annemergmed.20... ^-²¹21 Magid DJ, Sullivan AF, Cleary PD, Rao SR, Gordon JA, Kaushal R, et al. The safety of emergency care systems: results of a survey of clinicians in 65 US Emergency Departments. Ann Emerg Med. 2009;53(6):715-23. https://doi.org/10.1016/j.annemergmed.2008.10.007 https://doi.org/10.1016/j.annemergmed.20... ⁾	USA (2012, 2009)	55	9	β
8	ED Survey Indianapolis⁽²⁰20 Camargo Jr CA, Tsai CL, Sullivan AF, Cleary PD, Gordon JA, Guadagnoli E, et al. Safety climate and medical errors in 62 US emergency departments. Ann Emerg Med. 2012;60(5):555-63.e20. https://doi.org/10.1016/j.annemergmed.2012.02.018 https://doi.org/10.1016/j.annemergmed.20... ^,²²22 Wright ER, Linde B, Rau NL, Gayman M, Viggiano T. The effect of organizational climate on the clinical care of patients with mental health problems. J Emerg Nurs. 2003 Aug;29(4):314-21. https://doi.org/10.1067/men.2003.103 https://doi.org/10.1067/men.2003.103... ⁾	USA (2012, 2003)	67	10	β
9	EMS Safety Climate Scale⁽²³23 Eliseo LJ, Murray KA, White LF, Dyer S, Mitchell PA, Fernandez WG. EMS providers' perceptions of safety climate and adherence to safe work practices. Prehosp Emerg Care. 2012;16(1):53-8. https://doi.org/10.3109/10903127.2011.621043 https://doi.org/10.3109/10903127.2011.62... ⁾	USA (2012)	20	6	Ω
10	EMS-SI⁽²⁴24 Weaver MD, Wang HE, Fairbanks RJ, Patterson D. The association between EMS workplace safety culture and safefy outcomes. Prehosp Emerg Care. 2012;16(1):43-52. https://doi.org/10.3109/10903127.2011.614048 https://doi.org/10.3109/10903127.2011.61... ⁾	USA (2012)	44	6	Ω
11	Alberta Registered Nurse Survey⁽²⁵25 Mallidou AA, Cummings GG, Estabrooks CA, Giovannetti PB. Nurse specialty subcultures and patient outcomes in acute care hospitals: a multiple-group structural equation modeling. Int J Nurs Stud. 2011;48(1):81-93. https://doi.org/10.1016/j.ijnurstu.2010.06.002 https://doi.org/10.1016/j.ijnurstu.2010.... ⁾	Canada (2011)	20	12	α
12	Institute for Healthcare Improvement⁽²⁶26 Shaw KN, Ruddy RM, Olsen CS, Lillis KA, Mahajan PV, Dean JM, et al. Pediatric Patient Safety in Emergency Departments: unit characteristics and staff perceptions. Pediatrics 2009;124(2):485-93. https://doi.org/10.1542/peds.2008-2858 https://doi.org/10.1542/peds.2008-2858... ⁾	USA (2013)	19	4	β
13	EMS-SAQ⁽²⁷27 Patterson PD, Huang DT, Fairbanks RJ, Wang HE. The Emergency Medical Services Safety Attitudes Questionnaire. Am J Med Qual. 2010;25(2):109-15. https://doi.org/10.1177/1062860609352106 https://doi.org/10.1177/1062860609352106... ⁾	USA (2016)	30	6	Ω

	Dimensions/Domains	Instruments
1	Frequency of reported adverse events	HSOPSC; PSCS
2	Team work	HSOPSC; PSCS; SAQ-EMS; SAQ; RPPE; ED; EMS-SI
3	Expectations and actions of the management/supervision of the unit/service that favor safety	HSOPSC; PSCS
4	Organizational learning/continuous improvement	HSOPSC; PSCS
5	Hospital management support for patient safety	HSOPSC; PSCS
6	Safety perception	HSOPSC; PSCS; SAQ-EMS; SAQ; EMS-SI
7	Error feedback and communication	HSOPSC; PSCS
8	Opening for communications	HSOPSC; PSCS
9	Teamwork between units	HSOPSC; PSCS
10	Staff sizing	HSOPSC; PSCS; AACN HWEAT
11	Problems with shift changes and transitions between units/services	HSOPSC; PSCS
12	Non-punitive response to errors	HSOPSC; PSCS
13	Job satisfaction	SAQ-EMS; SAQ; EMS-SI; Alberta Registered Nurse Survey
14	Safety climate	SAQ-EMS; SAQ; PCQ-F; EMS-SI; Institute for Healthcare Improvement
15	Stress	SAQ-EMS; SAQ; EMS-SI
16	Work conditions	SAQ-EMS; SAQ; EMS-SI
17	True collaboration	AACN HWEAT
18	Skilled communication	AACN HWEAT
19	Effective decision-making	AACN HWEAT
20	Meaningful recognition	AACN HWEAT
21	Authentic leadership	AACN HWEAT
22	Climate of everydayness	PCQ-F
23	Climate of hospitality	PCQ-F
24	Handling disagreement and conflict	RPPE
25	Leadership and autonomy in clinical practice	RPPE
26	Internal work motivation	RPPE
27	Control over practice	RPPE
28	Communication about patient	RPPE
29	Staff relationships with physicians	RPPE
30	Physical environment	ED
31	Staffing	ED
32	Nursing	ED
33	Culture	ED
34	Triage and monitoring	ED
35	Information coordination and consultation	ED
3	In-patient coordination	ED
6	Availability of personal protective gear	EMS
37	Management support	EMS
38	Absence of job hindrances	EMS
39	Feedback/training	EMS
40	Cleanliness of workspace	EMS
41	Minimal conflict/good communication	EMS
42	Crowding	Institute for Healthcare Improvement
43	Communication/coordination of care	Institute for Healthcare Improvement
44	Medication safety	Institute for Healthcare Improvement
45	Quality of care	Alberta Registered Nurse Survey
46	Adverse patient events	Alberta Registered Nurse Survey
47	Experience full time/part time	Alberta Registered Nurse Survey
48	Salary	Alberta Registered Nurse Survey
49	Continuing education	Alberta Registered Nurse Survey
50	Quality assurance program	Alberta Registered Nurse Survey
51	Preceptorship	Alberta Registered Nurse Survey
52	Autonomy	Alberta Registered Nurse Survey
53	Control over practice	Alberta Registered Nurse Survey
54	RN-MD relationships	Alberta Registered Nurse Survey
55	Emotional exhaustion	Alberta Registered Nurse Survey
56	Staff crew safety	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association
57	Patient safety	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association
58	Flying status	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association
59	Close calls, near misses, or safety incidents	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association

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[1] Corresponding author: Gisele Torrente E-mail: torrentegisele@gmail.com