Perceptions Of Patient Safety Research Articles

Do marked discharge summaries with recommendation text boxes enhance patient safety? A nationwide survey.

Danish hospital physicians are required to mark their discharge summaries addressing whether the patient's general practitioner (GP) is recommended to follow up as well as suggest follow-up actions. To investigate whether a new form of discharge summaries may contribute to improve the perceived patient safety following transition from hospitals to general practice. This paper reports data from a questionnaire sent to a representative sample of GPs in Denmark. A questionnaire was prepared for GPs based on background material, focus group interviews and discussions with relevant professionals. It was subsequently pilot tested by fellow researchers and GPs and revised prior to the presently reported survey. Of 310 participating GPs, 197 (63%) 'totally agree' or 'partly agree' that the marked discharge summaries with a recommendation text box contribute to a better handover to general practice, and 223 (72%) 'totally agree' or 'partly agree' that they improve patient safety. The majority of responding GPs believe that the marked discharge summaries with a recommendation text box enhance patient safety and facilitate the transition of care to general practice following hospital discharge.

Exploring the Relationship Between Hospital Patient Safety Culture and Performance on Measures of Hospital-Acquired Conditions

Objective The aim of the study is to examine the relationship between hospital perceptions of patient safety culture and the incidence of hospital-acquired conditions (HACs) included in Medicare’s HAC Reduction Program utilizing updated and standardized metrics. Methods The pooled cross-sectional study design utilized the 2018 and 2021 datasets from (1) the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture (HSOPS), (2) the American Hospital Association’s annual survey, and (3) the Center for Medicare and Medicaid’s Hospital Compare dataset. The final analytic sample included 131 acute care, nonfederal, U.S. facilities. Multivariable linear regression models were used to compare the HSOPS domains of patient safety culture to CMS’s HAC metrics. Results Controlling for hospital structural and patient-mix characteristics, hospitals with higher staff-reported ratings of overall patient safety culture (‘overall perceptions of patient safety’ and ‘patient safety grade’) had significantly lower rates of HACs, including total HAC rate, catheter-associated urinary tract infections, and central line-associated blood stream infections (P’s < 0.000–0.044). Higher HSOPS domain scores were variably associated with lower HAC rates, with consistently significant associations found for domains related to nonpunitive, open communication (P’s < 0.05). Conclusions Our relatively robust results suggest that while patient safety culture may not be the only strategy necessary to improve HAC rates, it needs to be aligned with other efforts to improve quality and safety. This underscores the importance of cultivating a culture of psychological safety that promotes open feedback and communication about errors.

Patient Safety and Perception of Quality in University Dental Hospitals: A French National Survey

Objectives Patient safety is poorly developed in dentistry. The aim of this study was to evaluate the level of patient safety perception and quality culture in French university dental hospitals. Methods A national survey was performed using a questionnaire that was sent electronically to dental students, teachers, senior professionals, and paramedics of the university dental clinics that volunteered to participate. The profile of the respondents, their involvement in quality teams, the occurrence of adverse events, and the organization of the department were explored. Results Of the 17 university dental hospitals in France, 15 volunteered to participate, representing 681 respondents (65.9% students, 26.9% dentists, 3.7% paramedics, and 3.5% residents). Despite 58% of the respondents being aware of the procedure for declaring adverse events, only 28% of them had ever declared at least one. All professionals were aware of the high incidence of adverse events in their clinics. The perception of well-being and organization was low, especially for the items “adequation between tasks and number of professionals” and for “task organization.” The perception of “team spirit and feeling of respect” was good. Conclusions The survey highlighted the need for courses and meetings on patient safety and quality, but also the good perception of dental care providers regarding patient safety. The lack of materials and of human resources emerged as a key point for improving patient safety in university dental hospitals. Nonetheless, communication was also perceived as very important and could be improved without incurring costs and through internal solutions.

A-187 Program for Recognition of Patient Safety Cores in Diagnostic Services

Abstract Background Health services are complex and challenging structures, including diagnostic services. Therefore, it is everyone's responsibility to ensure patient safety. The scope of this study is to present the challenges and opportunities in structuring the Quality Management and Patient Safety System (QM&PS) of a large diagnostic service that culminated in the first laboratory to receive the Patient Safety Core Recognition Seal (NSP), a program established by the partnership of QGA (Quality Global Assurance) and IBSP (Brazilian Institute for Patient Safety). Methods The restructuring of the QM&PS began in 2018 and since then, 6 NSPs have been established, distributed across 6 regions of the Brazil, with procedures, regulations, confidentiality agreements, and responsibilities clearly defined. The NSP are multidisciplinary and discuss 13 safety indicators monthly, namely: adverse events, contrast extravasation, falls and faints, reactions to medications, contrasts, and vaccines, immunization errors - vaccine application and exchange, loss of noble samples, technovigilance, and pharmacovigilance. With an engaged and participative Medical Board, the Patient Safety Committee was created in 2020, with the participation of top management and representatives of strategic leaderships to discuss cases of serious adverse events and deaths with systemic outputs and plans. In 2022, we conducted the first Patient Safety Perception Survey, from which we extracted insights to further develop the safety culture. Six working groups were organized focusing on interaction between company committees and programs, institutional communication for sharing information and Patient Safety initiatives in the organization, identification, prevention, and monitoring of incidents, risk management tool for analysis of clarity, application, and relevance of use as support for management and continuing education. Results The working groups involved 58 professionals and resulted in 65 implemented actions. Among the main results achieved, we can highlight the implementation of the rapid response flow to SAE (serious adverse event), Just Culture Policy, Disclosure Protocol, Second Victim Care Flow, Safety Rite in Customer Service Units, Patient Safety Trail, Institutional Communication, and the Patient Safety Core Recognition Seal. Conclusions Patient Quality and Safety must be part of the institutional pillar, composing the Strategic Objectives to be achieved. It is necessary to engage the organization and rely on the involvement of leadership and physicians. As a large service, our biggest challenges are demonstrating the effectiveness of implemented improvement actions in the face of identified risk modifications, defining strategies to reduce underreporting, and being able to involve all collaborators and operational teams in the safety culture.

Patients and Healthcare Professionals’ Perceptions of Stethoscope Barriers

Stethoscope hygiene is rarely performed despite evidence that they are a potential source of nosocomial infections. Aseptic touch-free disposable stethoscope diaphragm barriers (touch-free barriers) provide a bacteriologically impervious surface; however, little is known about perceptions of touch-free barriers. The purpose of this study was to determine patients’ and healthcare professionals’ perceptions of stethoscope hygiene habits, cleanliness, and patient safety, after respondents viewed videos of stethoscope hygiene with alcohol versus a touch-free barrier, or no hygiene/no barrier. We conducted a cross-sectional study using survey methodology and convenience sampling. Participants viewed three short videos that showed a provider using each of three stethoscope hygiene techniques (barrier, alcohol, or none), followed by completion of a brief survey. Pearson’s chi-square, Fisher’s exact, Wilcoxon rank sum or Kruskal-Wallis tests were used as appropriate. Bonferroni correction was used to control error rate at 0.05 for each question. The sample size of 240 participants included 119 patients and 121 healthcare professionals. Patients rarely witnessed healthcare professionals cleaning stethoscopes, rated clean stethoscopes as important, and were more likely to choose touch-free barrier as easiest for providers. Healthcare professionals rated stethoscope hygiene as important, reported frequent stethoscope hygiene, and felt that touch-free barrier would improve workflow. Touch-free barriers were viewed positively by respondents. Hospitals should consider touch-free barriers as an important strategy to reduce nosocomial infections.

Could breaks reduce general practitioner burnout and improve safety? A daily diary study.

Rates of burnout are currently at record high levels, and GPs experience higher burnout than many other specialties. Organisational interventions may reduce burnout, but few studies have investigated these in primary care. The current study investigated whether breaks, both with and without social interactions, were associated with burnout and patient safety perceptions in GPs. A within-subjects, interval contingent, quantitative daily diary design. UK GP practices. Participants completed questionnaires at baseline measuring demographic variables, burnout and patient safety perceptions. They then completed a questionnaire in the evening each day for a week which captured whether they had taken a break that day, whether it involved a positive social interaction, burnout (comprising subscales of disengagement and exhaustion), positive and negative affect and patient safety perceptions. The data were analysed using hierarchical linear modelling to assess same-day and next-day associations. We included 241 responses from 58 GPs for analysis. Taking at least one break (involving any or no social interactions) was associated with lower disengagement that day and lower exhaustion the next day. Taking at least one break involving a positive interaction was associated with 1) lower disengagement, exhaustion, overall burnout and negative affect on the same day, as well as higher positive affect and improved perceptions of patient safety, and 2) lower exhaustion and improved patient safety perceptions on the next day. Organizing daily team or practice breaks where staff can socialise may help to reduce burnout and improve perceptions of patient safety.

Associations of perceptions of patient safety culture, job crafting, and perceptions of patient rounding with patient safety management activities among tertiary hospital nurses

Associations of perceptions of patient safety culture, job crafting, and perceptions of patient rounding with patient safety management activities among tertiary hospital nurses

Perceptions of hospital electronic health record (EHR) training, support, and patient safety by staff position and tenure

BackgroundHospitals rely on their electronic health record (EHR) systems to assist with the provision of safe, high quality, and efficient health care. However, EHR systems have been found to disrupt clinical workflows and may lead to unintended consequences associated with patient safety and health care professionals’ perceptions of and burden with EHR usability and interoperability. This study sought to explore the differences in staff perceptions of the usability and safety of their hospital EHR system by staff position and tenure.MethodsWe used data from the AHRQ Surveys on Patient Safety Culture® (SOPS®) Hospital Survey Version 1.0 Database and the SOPS Health Information Technology Patient Safety Supplemental Items (“Health IT item set”) collected from 44 hospitals and 8,880 staff in 2017. We used regression modeling to examine perceptions of EHR system training, EHR support & communication, EHR-related workflow, satisfaction with the EHR system, and the frequency of EHR-related patient safety and quality issues by staff position and tenure, while controlling for hospital ownership type and bed-size.ResultsIn comparison to RNs, pharmacists had significantly lower (unfavorable) scores for EHR system training (regression coefficient = -0.07; p = 0.047), and physicians, hospital management, and the IT staff were significantly more likely to report high frequency of inaccurate EHR information (ORs = 2.03, 1.34, 1.72, respectively). Compared to staff with 11 or more years of hospital tenure, new staff (less than 1 year at the hospital) had significantly lower scores for EHR system training, but higher scores for EHR support & communication (p < 0.0001). Dissatisfaction of the EHR system was highest among physicians and among staff with 11 or more years tenure at the hospital.ConclusionsThere were significant differences in the Health IT item set’s results across staff positions and hospital tenure. Hospitals can implement the SOPS Health IT Patient Safety Supplemental Items as a valuable tool for identifying incongruity in the perceptions of EHR usability and satisfaction across staff groups to inform targeted investment in EHR system training and support.

Parents' perceptions of patient safety in paediatric hospital care-A mixed-methods systematic review.

To identify and summarize evidence on paediatric patient safety in a hospital setting from parents' point of view. A mixed-methods systematic review. ID number CRD42023453626. PubMed, Scopus, ScienceDirect, the Cochrane Library and the Wiley database were searched in July 2023. Two researchers independently applied eligibility criteria, selected studies and conducted a quality appraisal. Data-based convergent synthesis and thematic content analysis were employed. Twelve studies were included: eight qualitative research studies, two cross-sectional studies, one non-randomized experimental study and one mixed-methods study. The results were grouped into two themes-parental perceptions of inclusion in paediatric patient safety and parental perceptions of exclusion from paediatric patient safety-and comprised seven main subthemes: comfort in communication, parental engagement, communication difficulties, withdrawal from activity, uncertainty about available information and threats to patient safety. Parents are willing to be engaged in care but require support from healthcare professionals, as they are often anxious about the condition of their children and actions they believe might be helpful. They need to be treated as valuable partners and be engaged in communication and decision processes. The development and implementation of interventions involving parents in ensuring the safety of hospitalized paediatric patients should be of the utmost priority to healthcare organizations, as the common theme throughout the included studies was the need for improved communication with and recognition of parents as allies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed. No Patient or Public Contribution.

The relationship between hospital patient safety culture and performance on Centers for Medicare & Medicaid Services value-based purchasing metrics.

Despite the intense policy focus on reducing health-care-associated conditions, adverse events in health care settings persist. Therefore, evaluating patient safety efforts and related health policy initiatives remains critical. The aim of this study was to explore the relationship between hospital patient safety culture and hospital performance on Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) metrics. A pooled cross-sectional study design was used utilizing three secondary datasets from 2018 and 2021: the Hospital Survey on Patient Safety Culture, the American Hospital Association annual survey, and the Hospital Compare data from CMS. We used two multivariable linear regression models to examine the relationship between organizational patient safety culture and hospital performance. The dependent variables included the overall CMS total performance score (TPS) and the four individual TPS domain scores. Hospital patient safety culture, the independent variable, was operationalized using two measures from the Hospital Survey on Patient Safety Culture: (a) the domain score of overall perceptions of patient safety and (b) the patient safety grade. We observed positive and significant associations between hospital patient safety culture and a hospital's overall TPS and the "patient and community engagement" and "safety" domains. Findings suggest that building a strong patient safety culture has the potential to lead health care organizations to achieve high performance on HVBP metrics. Our findings have important policy implications for both the future of CMS HVBP as a motivator of patient safety and how health care managers integrate culture change into programs to meet external quality metrics.

Safe provision of nursing care as predicted by nursing students: A cross-sectional study

Background &amp; Aim: Assessment of safety culture and nursing students’ competencies in patient safety is essential for readiness to provide quality and safe care. The objectives of the study are to examine how nursing students perceive patient safety culture and to evaluate factors that may influence their perceptions. Methods &amp; Materials: A descriptive cross-sectional study was conducted using the Slovak version of the Hospital Survey on Patient Safety Culture for Nursing Students and the Questionnaire for Measuring Demographic Variables and Information on the Education Process. The study involved 242 nursing students from two faculties in Slovakia. Data were analyzed using descriptive and inferential statistics. Results: None of the dimensions of patient safety culture was rated by the nursing students above the necessary level of 75 %. Statistically significant correlations and differences were found between the nursing students’ perceptions of patient safety culture and some selected sociodemographic variables. Multiple regression analysis revealed significant associations between the nursing students’ perceptions of patient safety culture and overall patient safety grade, the number of reported events in the workplace, and the number of reported events by nursing students. Conclusion: Recognising nursing students’ perceptions of patient safety culture enables identification of weaknesses, and early implementation of targeted interventions and educational initiatives to increase overall patient safety in care provision. Future research should focus on recognizing relationships between perceived patient safety culture, teamwork, education, and indicators of safe and quality care during clinical training from nursing students’ perspective.

Shaping Safety: Unveiling the Dynamics of Incident Reporting and Safety Culture in Saudi Arabian Healthcare.

Patient safety is a critical concern in healthcare systems worldwide. Understanding the interplay between safety culture and incident reporting behaviors among healthcare professionals is essential for improving patient outcomes. To examine the perception of patient safety culture among healthcare professionals in Saudi Arabia and its impact on their attitudes toward incident reporting, considering variables such as level of care, ownership, and professional background. A cross-sectional survey was distributed both online and onsite to 453 healthcare professionals, with 402 completing it. The survey assessed various dimensions of safety culture and incident reporting behaviors. Statistical analysis included correlation matrices, regression models, and comparative assessments across different types of hospital settings. The study revealed significant associations between perceived safety culture and incident reporting behaviors (p < 0.01). Specifically, management (B = 0.64, p < 0.01), working conditions (r = 0.51, p < 0.01), and job satisfaction (r = 0.52, p < 0.01) were identified as crucial for improvement. The study highlighted the importance of fostering a blame-free culture and establishing clear reporting guidelines to enhance reporting frequencies. Enhancing the perception of patient safety within healthcare settings positively influences the likelihood of incident reporting. Strategic interventions aimed at improving safety culture could significantly advance patient care quality.

Influence of patient safety perception and attitude on inpatients' willingness to participate in patient safety: An observation study.

Patient safety (PS) in clinical settings focuses primarily on ensuring active patient participation. However, there is limited understanding of patients' willingness to participate. This study aimed to investigate the association between PS perception, attitude, and inpatients' willingness to participate in PS. This cross-sectional study was conducted with 295 inpatients admitted to a tertiary hospital in South Korea between May and July 2023. Structured questionnaires were used to collect the data. The collected data were subjected to various analytical techniques including descriptive statistics, t tests, Pearson correlation analysis, and multiple regression analysis. Willingness to participate in PS of inpatients showed a statistically significant difference in PS education experience (t = -2.69, P = .008). There was a significant positive correlation between PS perception and attitude (r = .54, P < .001). Additionally, willingness to participate in PS had significant positive correlations with PS perception (r = .62, P < .001) and PS attitude (r = .48, P < .001). The factors influencing willingness to participate in PS were PS perception (β = .51, P < .001) and attitude (β = .20, P < .001). Based on these research findings, it is important to provide inpatients with education and campaigns to improve their perceptions and attitudes toward PS. In addition, it is essential to develop programs that encourage and support patient engagement in PS in hospitals. These efforts will promote active implementation of PS activities by inpatients in clinical settings.

Māori nurse practitioners: The intersection of patient safety and culturally safe care from an Indigenous lens.

Dynamic and complex health systems require innovative and adaptive solutions to support patient safety and achieve equitable health outcomes for Indigenous populations. Understanding the ways by which Indigenous (and specifically Māori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems. To describe Māori NPs perspectives on patient safety when caring for Māori and understand how Māori NPs deliver safe health care. A group of five Māori NPs worked alongside a Māori nurse researcher to explore their perceptions of patient safety. Together, they held an online hui (focus group) in early 2024. Data were analysed collectively, informed by kaupapa Māori principles, using reflexive thematic analysis. Māori NP experiences, expressions and understandings of patient safety envelop cultural safety and have many facets that are specific to the needs of Māori populations. The three themes showed: (1) Te hanga a te mahi: the intersection of cultural and clinical expertise; (2) Mātauranga tuku iho: the knowledge from within, where safe practice was strongly informed by traditional knowledge and cultural practice; (3) Te Ao hurihuri: walking in two worlds, where Māori NPs navigated the westernized health system's policies and practices while acting autonomously to advocate for and deliver culturally safe care. The Māori NP lens on patient safety is vital for promoting culturally responsive and effective health care. By recognizing the unique needs of Māori patients and families and incorporating cultural perspectives into practice, Māori NPs contribute to a more comprehensive and inclusive approach to patient safety that goes beyond westernized principles and practices. No patient or public contribution.

Patient safety — Are we speaking the same language?

BackgroundSince the radical years following the To Err is Human report, patient safety research has become settled on standardisation and audit cultures. Recent work suggests a change in direction. Current efforts exploring the intricate relationship between stability and change within organisations establish a more balanced patient safety perspective. Frontline staff insights are key to this new knowledge. AimThis study aims to explore the patient safety perceptions of registered nurses working directly with patients in acute care settings. MethodFacilitated reflexive workshops were conducted with nine wards from October to November 2022. Data analysis explored creative works and reflective notes of group discussions with frontline registered nurses using a critical lens. FindingsWe offer four analytical interpretations of how frontline registered nurses understand and experience patient safety. These are as follows: buzzwords, keep ME safe, listen to US, and this is MY role. These manifest the business of patient safety where nurses are, under siege, the silenced team member and experience tension between accountability and responsibility. DiscussionCritical questioning and reappraisal of patient safety practices require the vast knowledge of frontline staff to be fully utilised. ConclusionThis research reveals much of what is avoided in patient safety literature — the tension between what registered nurses understand, experience, and can deliver in patient safety practice. It challenges organisational leaders to enable and support frontline nurses in driving local change.

The influence of hospital accreditation on nurses’ perceptions of patient safety culture

ObjectivesHospitals’ accreditation process is carried out to enhance the quality of hospitals’ care and patient safety practices as well. The current study aimed to investigate the influence of hospitals’ accreditation on patient safety culture as perceived by Jordanian hospitals among nurses.MethodsA descriptive cross-sectional correlational survey was used for the current study, where the data were obtained from 395 nurses by convenient sampling technique who were working in 3 accredited hospitals with 254 nurses, and 3 non-accredited hospitals with 141 nurses, with a response rate of 89%.ResultsThe overall patient safety culture was (71.9%). Moreover, the results of the current study revealed that there were no statistically significant differences between the perceptions of nurses in accredited and non-accredited hospitals in terms of perceptions of patient safety culture.ConclusionThe current study will add new knowledge about nurses’ perceptions of patient safety culture in both accredited and non-accredited hospitals in Jordan which in turn will provide valid evidence to healthcare stakeholders if the accreditation status positively affects the nurses’ perceptions of patient safety culture or not. Continuous evaluation of the accreditation application needs to be carried out to improve healthcare services as well as quality and patient safety.

Healthcare workers perceptions of patient safety culture in selected Ghanaian regional hospitals: a qualitative study

BackgroundPatient safety culture is an integral part of healthcare delivery both in Ghana and globally. Therefore, understanding how frontline health workers perceive patient safety culture and the factors that influence it is very important. This qualitative study examined the health workers’ perceptions of patient safety culture in selected regional hospitals in Ghana.ObjectiveThis study aimed to provide a voice concerning how frontline health workers perceive patient safety culture and explain the major barriers in ensuring it.MethodIn-depth semi-structured interviews were conducted with 42 health professionals in two regional government hospitals in Ghana from March to June 2022. Participants were purposively selected and included medical doctors, nurses, pharmacists, administrators, and clinical service staff members. The inclusion criteria were one or more years of clinical experience. Interviews were recorded and transcribed. Thematic analysis was used to identify themes.ResultThe health professionals interviewed were 38% male and 62% female, of whom 54% were nurses, 4% were midwives, 28% were medical doctors; lab technicians, pharmacists, and human resources workers represented 2% each; and 4% were critical health nurses. Among them, 64% held a diploma and 36% held a degree or above. This study identified four main areas: general knowledge of patient safety culture, guidelines and procedures, attitudes of frontline health workers, and upgrading patient safety culture.ConclusionsThis qualitative study presents a few areas for improvement in patient safety culture. Despite their positive attitudes and knowledge of patient safety, healthcare workers expressed concerns about the implementation of patient safety policies outlined by hospitals. Healthcare professionals perceived that curriculum training on patient safety during school education and the availability of dedicated officers for patient safety at their facilities may help improve patient safety.

Nursing students’ perspectives on patients' safety competencies: a cross-sectional survey

BackgroundNurses constitute the largest body of healthcare professionals globally, positioning them at the forefront of enhancing patient safety. Despite their crucial role, there is a notable gap in the literature regarding the comprehension and competency of nursing students in patient safety within Egypt. This gap underscores the urgent need for research to explore how nursing students perceive patient safety and the extent to which these competencies are integrated into their clinical and educational experiences. Understanding these perspectives is essential for developing targeted interventions that can significantly improve patient safety outcomes. The objective of this study was to fill this gap by assessing the perspectives of nursing intern students on patient safety competencies, thereby contributing to the global efforts in enhancing patient safety education and practice.MethodsIn this research, a cross-sectional study design was employed to investigate the topic at hand. A purposive sample of 266 nursing intern students was enrolled from the Faculty of Nursing at Mansoura University. The data were collected using a patient safety survey. Subsequently, the collected data underwent analysis through the application of descriptive and inferential statistical techniques using SPSS-20 software.ResultsAmong the studied intern nursing students, we found that 55.3% and 59.4% of the involved students agreed that they could understand the concept of patient safety and the burden of medical errors. Regarding clinical safety issues, 51.1% and 54.9% of the participating students agreed that they felt confident in what they had learned about identifying patients correctly and avoiding surgical errors, respectively. Concerning error reporting issues, 40.2% and 37.2% of the involved students agreed that they were aware of error reports and enumerated the barriers to incident reporting, respectively. There was a statistically significant difference between the nursing student patient safety overview domain and their age (p = 0.025).ConclusionsOur study's compelling data demonstrated that intern students who took part in the patient safety survey scored higher overall in all patient safety-related categories. However, problems with error reporting showed the lowest percentage. The intern students would benefit from additional educational and training workshops to increase their perspectives on patients' safety competencies.

Psychosocial working conditions, perceived patient safety and their association in emergency medical services workers in Germany - a cross-sectional study.

Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety. For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services - Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c). The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress. Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads.

Assessment of Patient Safety Culture Among Nurses Working at Tertiary Care Hospitals in Aljouf Region, Saudi Arabia.

Patient safety is a fundamental element in healthcare quality and a major challenge in achieving universal health coverage, especially in low- and middle-income countries. The first step to improve patient safety is to evaluate the safety culture in hospitals. This study aimed to investigate the patient safety culture among nurses and determine the factors affecting it. This cross-sectional study was conducted among 423 nurses working at tertiary care hospitals in the Al-Jouf region in Saudi Arabia. The highest score for patient safety among nurses was for teamwork within units (16.41 ± 2.44). The lowest score was for nonpunitive response to errors (5.87 ± 1.92). In addition, 83% of the participants did not report any events in the past 12 months. More perception of patient safety was significantly higher among females than males in dimensions of teamwork within units, frequency of events reported, and staffing. Furthermore, teamwork within units, management support for patient safety, staffing, non-punitive response to errors, and handoffs and transitions were significantly higher among participants in direct contact with patients. The Hospital Survey on Patient Safety Culture (HSOPSC) scale is significantly higher among non-Saudi nurses, nurses with bachelor's education, nurses with less working hours per week, and those who had training on patient safety. The current study showed that the majority of the participants did not report any events in the past 12 months. The highest score for patient safety culture dimensions among nurses was for teamwork within units while the lowest score was for nonpunitive response to errors.