Patient safety: latent risk factors van Beuzekom, M; Boer, F; Akerboom, S ...
British journal of anaesthesia : BJA,
07/2010, Letnik:
105, Številka:
1
Journal Article
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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.
Measuring patient satisfaction after anaesthesia care is complex. The existing patient satisfaction questionnaires are limited and omit aspects of patient satisfaction, such as professional ...competence, information provision, service, and staff–patient relationship. The aim of our study was to develop a valid and reliable self-reported multidimensional questionnaire assessing patient satisfaction that included these issues.
The development of the Leiden Perioperative care Patient Satisfaction questionnaire (LPPSq) was as follows: expert consultation, construction of the pilot questionnaire, pilot study, statistical analysis of the results of the pilot study (validity, reliability, and factor analysis), compilation of the definitive questionnaire, main study, and repeated statistical analysis (validity, reliability, and factor analysis). The overall patient satisfaction is expressed by the mean satisfaction score.
Three hundred and eighty-two patients consented to participate in the study; 80.4% of the patients (n=307) completed the questionnaire. The LPPSq isolated three dimensions: information (Cronbach's α=0.82), fear and concern (Cronbach's α=0.69), and staff–patient relationship (Cronbach's α=0.94). Patient satisfaction with perioperative care was not directly dependent on the outcomes of anaesthesia but how patients were approached and the amount of information they received. Age (P=0.001), gender (P=0.001), work situation (P=0.003), and specialty (P=0.017) were the characteristics most influencing patient satisfaction.
We developed the LPPSq questionnaire to measure patient satisfaction with perioperative care, of which anaesthesia care is an important element. In this study, information provision and the relationship between staff and patient were the major determinants of patient satisfaction.
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