Abstract
Key validated clinical metrics are being used individually and in aggregate (Baby-MONITOR) to monitor the performance of neonatal intensive care units (NICUs). The degree to which perceptions of key components of safety culture, safety climate, and teamwork are related to aspects of NICU quality of care is poorly understood. The objective of this study was to test whether NICU performance on key clinical metrics correlates with caregiver perceptions of safety culture. Cross-sectional study of 6253 very low-birth-weight infants in 44 NICUs. We measured clinical quality via the Baby-MONITOR and its nine risk-adjusted and standardized subcomponents (antenatal corticosteroids, hypothermia, pneumothorax, healthcare-associated infection, chronic lung disease, retinopathy screen, discharge on any human milk, growth velocity, and mortality). A voluntary sample of 2073 of 3294 eligible professional caregivers provided ratings of safety and teamwork climate using the Safety Attitudes Questionnaire. We examined NICU-level variation across clinical and safety culture ratings and conducted correlation analysis of these dimensions. We found significant variation in clinical and safety culture metrics across NICUs. Neonatal intensive care unit teamwork and safety climate ratings were correlated with absence of healthcare-associated infection (r = 0.39 [P = 0.01] and r = 0.29 [P = 0.05], respectively). None of the other clinical metrics, individual or composite, were significantly correlated with teamwork or safety climate. Neonatal intensive care unit teamwork and safety climate were correlated with healthcare-associated infections but not with other quality metrics. Linkages to clinical measures of quality require additional research.
Highlights
Neonatal intensive care unit teamwork and safety climate were correlated with healthcare-associated infections but not with other quality metrics
The Joint Commission includes the establishment of a culture of safety as a critical component for achieving highly reliable and safe care[1] and requires hospitals to measure and monitor safety culture in an ongoing fashion.[2]
Based on the associations of quality of care delivery with health worker assessments of safety and teamwork climate in other areas of medicine, we hypothesized that caregiver assessments of teamwork and safety climate would correlate with clinical metrics of quality for VLBW infants in the neonatal intensive care units (NICUs) setting, using the BabyMONITOR and its individual subcomponents. This cross-sectional study combined registry data routinely submitted by NICU members of the CPQCC17 with a voluntary sample of healthcare workers, participating in two simultaneous quality improvement initiatives, organized by the California Perinatal Quality Care Collaborative (CPQCC) focused on Delivery Room Management
Summary
Key validated clinical metrics are being used individually and in aggregate (Baby-MONITOR) to monitor the performance of neonatal intensive care units (NICUs). The objective of this study was to test whether NICU performance on key clinical metrics correlates with caregiver perceptions of safety culture. Study Design: Cross-sectional study of 6253 very low-birth-weight infants in 44 NICUs. We measured clinical quality via the Baby-MONITOR and its nine risk-adjusted and standardized subcomponents (antenatal corticosteroids, hypothermia, pneumothorax, healthcare-associated infection, chronic lung disease, retinopathy screen, discharge on any human milk, growth velocity, and mortality). Results: We found significant variation in clinical and safety culture metrics across NICUs. Neonatal intensive care unit teamwork and safety climate ratings were correlated with absence of healthcare-associated infection (r = 0.39 [P = 0.01] and r = 0.29 [P = 0.05], respectively). None of the other clinical metrics, individual or composite, were significantly correlated with teamwork or safety climate
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