Perception of patient safety differs by clinical area and discipline.

BACKGROUND: Current thinking about patient safety emphasizes the relationship between organizational factors, that is, latent risk factors (LRFs) and patient safety. This study explores the influence of the operating theatre (OT), intensive care unit (ICU), and disciplines on ratings of LRFs. If we have an understanding of the contribution made by these factors, we can identify significant points from which we can promote a safe environment. METHODS: Staff in four university hospitals were sent a survey relating to the state of LRFs, which included communication, planning and coordination, design, maintenance, equipment, teamwork, team instructions, housekeeping, situational awareness, hierarchy, and procedures. RESULTS: The ICU staff had more favourable perceptions of training, communication, team instruction, and hierarchy. The OT staff had more favourable perceptions of technical LRFs. We found three profiles for disciplines: (i) anaesthetists and intensivists had more favourable perceptions of technical LRFs than surgeons and nurses. (ii) Anaesthetists, anaesthesia nurse-technicians, and recovery nurses had a poorer perception of non-technical skills. (iii) Anaesthesia nurse-technicians and recovery nurses had less favourable perceptions of procedures, housekeeping, and situational awareness than anaesthetists and intensivists. CONCLUSIONS: As healthcare focuses its safety efforts towards system issues rather than towards the individual provider of care, attention has turned to organizational factors, known as LRFs. Understanding how LRFs affect safety should enable us to design more effective measures that will improve overall safety. Strategies for improving patient safety should be tailored specifically for various clinical areas and disciplines.

Patient safety: latent risk factors.

The person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an error. An alternative is the systems-centred approach, in which attention is paid to the organizational factors that create precursors for individual errors. This approach assumes that since humans are fallible, systems must be designed to prevent humans from making errors or to be tolerant to those errors. The questions raised by this approach might, for example, include asking why an individual had specific gaps in their knowledge, experience, or ability. The systems approach focuses on working conditions rather than on errors of individuals, as the likelihood of specific errors increases with unfavourable conditions. Since the factors that promote errors are not directly visible in the working environment, they are described as latent risk factors (LRFs). Safety failures in anaesthesia, in particular, and medicine, in general, result from multiple unfavourable LRFs, so we propose that effective interventions require that attention is paid to interactions between multiple factors and actors. Understanding how LRFs affect safety can enable us to design more effective control measures that will impact significantly on both individual performance and patient outcomes.

Survival with AIDS in Massachusetts, 1979 to 1989.

OBJECTIVES: The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival. METHODS: We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988. RESULTS: Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P = .001), and a history of intravenous drug use (P < or = .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .0001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time. CONCLUSIONS: With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis.