Patient safety culture in Italian out-of-hours primary care service: a national cross-sectional survey study.

Jacopo Demurtas,Stefano Celotto,Nicola Veronese,Pierpaolo Marchetti,Alberto Vaona,Dag Hofoss,Ellen Catharina Deilkås,Gunnar Tschudi Bondevik

doi:10.3399/bjgpopen20x101098

Abstract

BackgroundOut-of-hours (OOH) services in Italy provide >10 million consultations every year. To the authors' knowledge, no data on patient safety culture (PSC) have been reported.AimTo assess PSC in the Italian OOH setting.Design & settingNational cross-sectional survey using the Safety Attitudes Questionnaire — Ambulatory Version (SAQ-AV).MethodThe SAQ-AV was translated into Italian and distributed in a convenience sample of OOH doctors in 2015. Answers were collected anonymously by Qualtrics. Stata (version 14) was used to estimate Cronbach’s alpha, perform exploratory and confirmatory factor analysis, correlate items to doctors’ characteristics, and to do item descriptive analysis.ResultsOverall, 692 OOH doctors were contacted, with a 71% response rate. In the exploratory factor analysis (EFA), four factors were identified: Communication and Safety Climate (14 items); Perceptions of Management (eight items); Workload and Clinical Risk (six items); and Burnout Risk (four items).These four factors accounted for 68% of the total variance (Kaiser–Meyer–Olkin [KMO] statistic = 0.843). Cronbach’s alpha ranged from 0.710–0.917. OOH doctors were often dissatisfied with their job; there is insufficient staff to provide optimal care and there is no training or supervision for new personnel and family medicine trainees. Service managers are perceived as distant, with particular issues concerning the communication between managers and OOH doctors. A large proportion of OOH doctors (56.8%) state that they do not receive adequate support.ConclusionThese findings could be useful for informing policies on how to improve PSC in Italian OOH service.

Highlights

The Italian Out-of-h ours (OOH) service provides >10 million consultations every year and ensures care for patients with urgent healthcare needs.[1]
Service managers are perceived as distant, with particular issues concerning the communication between managers and OOH doctors
A large proportion of OOH doctors (56.8%) state that they do not receive adequate support. These findings could be useful for informing policies on how to improve patient safety culture (PSC) in Italian OOH service

Summary

Introduction

The Italian OOH service provides >10 million consultations every year and ensures care for patients with urgent healthcare needs.[1] Safe, good, consistent, and effective OOH primary care services are crucial for providing care as close to a patient’s home as possible.[1,2,3,4]. Born in aviation and in the military field,[7,8] was the model for patient safety attitudes of healthcare providers[2] and for the Safety Attitude Questionnaire (SAQ),[9,10] widely used in hospital settings and adapted to outpatient primary care setting in an SAQ-A mbulatory Version (SAQ-AV).[2,11,12]. To the authors' knowledge, no data on patient safety culture (PSC) have been reported

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