Dataset Information

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

ABSTRACT:

Background

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).

Methods

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 (ResultsNICUs 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.

Conclusions

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.

SUBMITTER: Tawfik DS

PROVIDER: S-EPMC6805564 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Tawfik Daniel S DS Thomas Eric J EJ Vogus Timothy J TJ Liu Jessica B JB Sharek Paul J PJ Nisbet Courtney C CC Lee Henry C HC Sexton J Bryan JB Profit Jochen J

BMC health services research 20191022 1

<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>Met ...[more]

PMID: 31640679

Similar Datasets

Project description:While survival rates for preterm infants have increased, the risk for adverse long-term neurodevelopmental and behavioral outcomes remains very high. In response to the need for novel, evidence-based interventions that prevent such outcomes, we have assessed Family Nurture Intervention (FNI), a novel dual mother-infant intervention implemented while the infant is in the Neonatal Intensive Care Unit (NICU). Here, we report the first trial results, including the primary outcome measure, length of stay in the NICU and, the feasibility and safety of its implementation in a high acuity level IV NICU.The FNI trial is a single center, parallel-group, randomized controlled trial at Morgan Stanley Children's Hospital for mothers and their singleton or twin infants of 26-34 weeks gestation. Families were randomized to standard care (SC) or (FNI). FNI was implemented by nurture specialists trained to facilitate affective communication between mother and infant during specified calming interactions. These interactions included scent cloth exchange, sustained touch, vocal soothing and eye contact, wrapped or skin-to-skin holding, plus family-based support interactions.A total of 826 infants born between 26 and 34 weeks during the 3.5 year study period were admitted to the NICU. After infant and mother screening plus exclusion due to circumstances that prevented the family from participating, 373 infants were eligible for the study. Of these, we were unable to schedule a consent meeting with 56, and consent was withheld by 165. Consent was obtained for 150 infants from 115 families. The infants were block randomized to groups of N?=?78, FNI and N?=?72, SC. Sixteen (9.6%) of the randomized infants did not complete the study to home discharge, 7% of those randomized to SC and 12% of FNI infants. Mothers in the intervention group engaged in 3 to 4 facilitated one- to two-hour sessions/week. Intent to treat analyses revealed no significant difference between groups in medical complications. The mean length of stay was not significantly affected by the intervention.There was no significant effect demonstrated with this intervention amount on the primary short-term outcome, length of stay. FNI can be safely and feasibly implemented within a level IV NICU.Clinicaltrials.gov: NCT01439269.

Project description:Performance measures, particularly pay for performance, may have unintended consequences for safety-net institutions caring for disproportionate shares of Medicaid or uninsured patients.To describe emergency department (ED) compliance with proposed length-of-stay measures for admissions (8 hours or 480 minutes) and discharges, transfers, and observations (4 hours or 240 minutes) by safety-net status.The 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS) ED data were stratified by safety-net status (Centers for Disease Control and Prevention definition) and disposition (admission, discharge, observation, transfer). The 2008 NHAMCS is a national probability sample of 396 hospitals (90.2% unweighted response rate) and 34 134 patient records. Visits were excluded for patients younger than 18 years, missing length-of-stay data or dispositions of missing, other, left against medical advice, or dead on arrival. Median and 90th percentile ED lengths of stay were calculated for each disposition and admission/discharge subcategories (critical care, psychiatric, routine) stratified by safety-net status. Multivariable analyses determined associations with length-of-stay measure compliance.Emergency Department length-of-stay measure compliance by disposition and safety-net status.Of the 72.1% ED visits (N = 24 719) included in the analysis, 42.3% were to safety-net EDs and 57.7% were to non-safety-net EDs. The median length of stay for safety-net was 269 minutes (interquartile range [IQR], 178-397 minutes) for admission vs 281 minutes (IQR, 178-401 minutes) for non-safety-net EDs; 156 minutes (IQR, 95-239 minutes) for discharge vs 148 minutes (IQR, 88-238 minutes); 355 minutes (IQR, 221-675 minutes) for observations vs 298 minutes (IQR, 195-440 minutes); and 235 minutes (IQR, 155-378 minutes) for transfers vs 239 minutes (IQR, 142-368 minutes). Safety-net status was not independently associated with compliance with ED length-of-stay measures; the odds ratio was 0.83 for admissions (95% CI, 0.52-1.34); 1.03 for discharges (95% CI, 0.83-1.27); 1.05 for observations (95% CI, 0.57-1.95), 1.30 for transfers (95% CI, 0.70-2.45]); or subcategories except for psychiatric discharges (1.67, [95% CI, 1.02-2.74]).Compliance with proposed ED length-of-stay measures for admissions, discharges, transfers, and observations did not differ significantly between safety-net and non-safety-net hospitals.

Project description:BackgroundExclusive breastfeeding is an essential need for mothers and newborn babies, but cultural practices and employment demands significantly influence feeding practices. The association between neonatal intensive care unit (NICU) admission and breastfeeding outcomes are variable. Data for Qatar and Middle East, in particular, are limited. Hence, this study aims to estimate the rate of breastfeeding at the time of NICU discharge and the rate of successful breastfeeding after NICU discharge in Qatar during well-baby follow-ups.MethodsThis quantitative longitudinal study was conducted over 18 months from January 2019 and included neonates born in Al Wakra Hospital admitted to the NICU. Demographic data, feeding during NICU stay and at discharge were obtained from lactation charts. Data regarding feeding practices after discharge were obtained through a questionnaire administered at 4 weeks and 8 weeks in well-baby clinics. Descriptive statistics and logistic regression analyses were performed to determine the rates of breastfeeding and the association between the various factors.ResultsOf the 678 participants screened, 364 were eligible for analysis. The rates of exclusive breastfeeding were 20% (73/364), 54% (197/364) and 42% (153/364) at discharge, 4 weeks and 8 weeks, respectively. Any breastfeeding was 64% (233/364), 40% (146/364) and 43% (157/364) at discharge, 4 weeks and 8 weeks, respectively. Logistic regression analysis showed that neonates who had NICU stays longer than 4 days had a higher rate of exclusive breastfeeding at discharge (adjusted odds ratio 3.000; 95% CI 1.25, 7.198) but had a reduced rate of breastfeeding and higher rate of formula feeding during follow-ups. Although breastfeeding rates were better in preterm infants at NICU discharge, regression analysis showed that none of the other factors, including gestation and maternal education had a significant association with the rate of exclusive breastfeeding at the time of discharge or during follow-ups.ConclusionsThe overall breastfeeding rates from this level II NICU in Qatar are better than previously available data. Studies with extended follow-up and assessment of intervention methods should be planned to improve and sustain the practice of exclusive breastfeeding.

Dataset Information

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

Background

Methods

Conclusions

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets