Supporting Error Management and Safety Climate in Ambulatory Care Practices: The CIRSforte Study.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101233393 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1549-8425 (Electronic) Linking ISSN: 15498417 NLM ISO Abbreviation: J Patient Saf Subsets: MEDLINE

Original Publication: Philadelphia, Pa. : Lippincott Williams & Wilkins, c2005-

Safety Management* ; Ambulatory Care* ; Organizational Culture* ; Patient Safety* ; Medical Errors*/prevention & control; Humans ; Prospective Studies ; Germany ; Surveys and Questionnaires ; Female ; Male

Background: To improve patient safety, it is important that healthcare facilities learn from critical incidents. Tools such as reporting and learning systems and team meetings structure error management and promote learning from incidents. To enhance error management in ambulatory care practices, it is important to promote a climate of safety and ensure personnel share views on safety policies and procedures. In contrast to the hospital sector, little research has been dedicated to developing feasible approaches to supporting error management and safety climate in ambulatory care. In this study, we developed, implemented, and evaluated a multicomponent intervention to address how error management and safety climate can be improved in ambulatory care practices.
Methods: In a prospective 1-group pretest-posttest implementation study, we sought to encourage teams in German ambulatory practices to use proven methods such as guidelines, workshops, e-learning, (online) meetings, and e-mail newsletters. A pretest-posttest questionnaire was used to evaluate level and strength of safety climate and psychological behavioral determinants for systematic error management. Using 3 short surveys, we also assessed the state of error management in the participating practices. In semistructured interviews, we asked participants for their views on our intervention measures.
Results: Overall, 184 ambulatory care practices nationwide agreed to participate. Level of safety climate and safety climate strength (rwg) improved significantly. Of psychological behavioral determinants, significant improvements could be seen in "action/coping planning" and "action control." Seventy-six percent of practices implemented a new reporting and learning system or modified their existing system. The exchange of information between practices also increased over time. Interviews showed that the introductory workshop and provided materials such as report forms or instructions for team meetings were regarded as helpful.
Conclusions: A significant improvement in safety climate level and strength, as well as participants' knowledge of how to analyze critical incidents, derive preventive measures and develop concrete plans suggest that it is important to train practice teams, to provide practical tips and tools, and to facilitate the exchange of information between practices. Future randomized and controlled intervention trials should confirm the effectiveness of our multicomponent intervention.Trial registration: Retrospectively registered on 18. November 2019 in German Clinical Trials Register No. DRKS00019053.
Competing Interests: This study was funded by the Innovation Fund of the German Federal Joint Committee (grant number 01VSF16021). The institutions of BSM, DL, D. Schütze, TB, M. Pommée, HM, KR, CT, RS, CG, M. Paulitsch, and FMG received the grant. The funder played no role in designing the study, in the collection, analysis and interpretation of data, or in writing the manuscript. The other authors have no conflicts of interest to declare.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

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Date Created: 20240315 Date Completed: 20240719 Latest Revision: 20240719

20240719

10.1097/PTS.0000000000001225

38489154