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Safety climate, safety climate strength, and length of stay in the NICU.

dc.contributor.author Tawfik, Daniel S
dc.contributor.author Thomas, Eric J
dc.contributor.author Vogus, Timothy J
dc.contributor.author Liu, Jessica B
dc.contributor.author Sharek, Paul J
dc.contributor.author Nisbet, Courtney C
dc.contributor.author Lee, Henry C
dc.contributor.author Sexton, J Bryan
dc.contributor.author Profit, Jochen
dc.date.accessioned 2021-09-01T14:04:19Z
dc.date.available 2021-09-01T14:04:19Z
dc.date.issued 2019-10-22
dc.identifier 10.1186/s12913-019-4592-1
dc.identifier.issn 1472-6963
dc.identifier.issn 1472-6963
dc.identifier.uri https://hdl.handle.net/10161/23684
dc.description.abstract <h4>Background</h4>Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs).<h4>Methods</h4>Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU's respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality.<h4>Results</h4>NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes.<h4>Conclusions</h4>Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals.
dc.language eng
dc.publisher Springer Science and Business Media LLC
dc.relation.ispartof BMC health services research
dc.relation.isversionof 10.1186/s12913-019-4592-1
dc.subject Humans
dc.subject Length of Stay
dc.subject Infant, Newborn
dc.subject Infant, Very Low Birth Weight
dc.subject Intensive Care Units, Neonatal
dc.subject Organizational Culture
dc.subject Female
dc.subject Male
dc.subject Patient Safety
dc.title Safety climate, safety climate strength, and length of stay in the NICU.
dc.type Journal article
duke.contributor.id Sexton, J Bryan|0517301
dc.date.updated 2021-09-01T14:04:17Z
pubs.begin-page 738
pubs.issue 1
pubs.organisational-group School of Medicine
pubs.organisational-group Psychiatry & Behavioral Sciences, General Psychiatry
pubs.organisational-group Duke
pubs.organisational-group Psychiatry & Behavioral Sciences
pubs.organisational-group Clinical Science Departments
pubs.publication-status Published
pubs.volume 19


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