Safety Culture and Surgical Site Infection Outcomes After Abdominal Hysterectomy [342

Abstract

INTRODUCTION: Previous studies demonstrate that hospital workplace culture may affect surgical outcomes. We designed a study evaluating the role of culture on surgical site infection after abdominal hysterectomy. METHODS: Data were collected from eight Minnesota community hospitals participating in a quality measurement collaborative from January 1 to December 31, 2012. Safety culture was measured using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture instrument; surgical site infection was measured using National Healthcare Safety Network definitions. RESULTS: Median hospital size was 93 beds (range 57–426 beds) and mean survey response rate of staff was 44%. Rates of surgical site infection after abdominal hysterectomy ranged from 0% to 5.26%; median abdominal hysterectomy performed was 33 (range 10–276). Safety culture scores ranged from 16 to 92 on a scale of 0–100. Eight dimensions of safety culture were inversely associated with abdominal hysterectomy SSI rates: supervisor expectations and actions (r=−0.93; 95% CI [−0.66, −0.99]), teamwork across units (r=−0.87; 95% CI [−0.43, −0.98]), organizational learning (r=−0.87; 95% CI [−0.43, −0.98]), feedback and communication about error (r=−0.87; 95% CI [−0.41, −0.98]), overall perception of safety (r=−0.84; 95% CI [−0.34, −0.97]), management support for patient safety (r=−0.82; 95% CI [−0.27, −0.97]), frequency of event reporting (r=−0.77; 95% CI [−0.15, −0.96]), and teamwork within the unit (r=−0.77; 95% CI [−0.14, −0.96]). CONCLUSION: In a cohort of community hospitals, there was a strong association between safety culture and risk of abdominal hysterectomy surgical site infection. These data suggest a strong role for safety culture, teamwork culture, and engaged hospital management in creating high-quality surgical outcomes.