AHRQ: Good teamwork but weak in handoffs

When it comes to measuring patient safety, hospitals tend to receive good scores for teamwork and education, but there still is considerable room for improvement with handoffs and other concerns. Those are some of the findings from the fifth annual edition of the Hospital Survey on Patient Safety Culture 2011 User Comparative Database Report from the Agency for Healthcare Research and Quality (AHRQ).

The first annual comparative database report was released in 2007 and included data from 382 U.S. hospitals. This year's report displays results from 1,032 hospitals and 472,397 hospital staff respondents. The 2011 report also includes a chapter on trending that presents results showing change over time for 512 hospitals that administered the survey and submitted data more than once.

Results are expressed in terms of percent positive, which is the percentage of positive responses (agree, strongly agree) to positively worded items such as "People support one another in this unit" or negative responses (disagree) to negatively worded items such as "We have safety problems in this unit."

Three areas of strength emerged in the 2011 results:

• Teamwork within units (average 80% positive response) — This composite is defined as the extent to which staff support each other, treat each other with respect, and work together as a team. This composite had the highest average % positive response.

• Supervisor/manager expectations and actions promoting patient safety (average 75% positive response) — This composite is defined as the extent to which supervisors/managers consider staff suggestions for improving patient safety, praise staff for following patient safety procedures, and do not overlook patient safety problems. This composite had the second highest average % positive response.

• Patient safety grade — On average, most respondents within hospitals (75%) gave their work area or unit a grade of "A — Excellent" (29%) or "B — Very Good" (46%) on patient safety.

There also were three areas that showed potential for improvement:

• Nonpunitive response to error (average 44% positive response) — This composite is defined as the extent to which staff feel that their mistakes and event reports are not held against them and that mistakes are not kept in their personnel file. This composite had the lowest average % positive response.

• Handoffs and transitions (average 45% positive response) — This composite is defined as the extent to which important patient care information is transferred across hospital units and during shift changes. This composite had the second lowest average % positive response.

• Number of events reported — On average, most respondents within hospitals (54%) reported no events in their hospital over the past 12 months. It is likely that events were underreported. This is an area for improvement for most hospitals, the AHRQ report says, because underreporting of events means potential patient safety problems might not be recognized or identified and therefore might not be addressed.

Breaking down the results by hospital and individual characteristics also yielded interesting results. These are some of the highlights from the report:

• Very small hospitals (6-24 beds) had the highest overall average % positive response on the patient safety culture composites.

• Small hospitals (25-49 beds) had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (81% positive for 25-49 beds vs. 70% for 400 beds or more).

• Nonteaching hospitals had a higher average percent positive response than teaching hospitals on Teamwork Across Units (60% positive compared with 55% positive) and Handoffs and Transitions (47% positive compared with 42%).

• Non-government-owned hospitals had a higher percentage of respondents who reported one or more events in the past year (47%) than government-owned hospitals (42%).

• East South Central and West South Central hospitals had the highest average percent positive response across the composites (66% positive); New England hospitals had the lowest (59% positive).

• Mid-Atlantic, East South Central, and West South Central hospitals scored highest on the percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (78%).

• Pacific hospitals had the highest percentage of respondents who reported one or more events in the past year (51%). The lowest percentage of respondents reporting events was in the West South Central region (43%).

• Respondents in rehabilitation had the highest average percent positive response across the composites (69% positive). Emergency had the lowest (57% positive).

• Rehabilitation had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (84%). Emergency had the lowest (63%).

• Intensive care units (any type) had the highest percentage of respondents reporting one or more events in the past year (63%). Rehabilitation had the lowest (42%).

• Respondents in administration/management had the highest average percent positive response across the composites (74% positive). Pharmacists had the lowest (60% positive).

• Administration/management had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good"(86%). Pharmacists had the lowest (67%).

• Pharmacists had the highest percentage of respondents reporting one or more events in the past year (72%). Unit assistants/clerks/secretaries had the lowest (18%).