Hospital Patient Safety Culture and Hospital Readmission

1Northwestern University Feinberg School of Medicine, Chicago, IL
2Harvard School of Public Health, Boston, MA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 60

Background:

Preventable hospital readmission is a prominent consideration in policy discussions aimed at reducing morbidity and cost in the United States health care system. Research shows patients are more likely to be readmitted after discharge from hospitals with worse safety performance as reflected by a higher incidence of Patient Safety Indicators (PSIs). Hospital patient safety culture — defined as a hospital's organizational culture as related to patient safety — is believed to be one determinant of hospital patient safety performance and may be associated with readmission.

Methods:

A safety climate survey was administered to a random sample of hospital employees (n = 36,375) from 69 hospitals between July 2006 and May 2007. For each hospital, a percent problematic response (PPR) was calculated for each survey item, for 12 conceptual component dimensions of safety climate, and for safety climate as a whole. Robust multiple regression models were estimated in which 30‐day risk‐adjusted readmission rates were the dependent variables in separate disease‐specific models [acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia] and measures of safety climate were the independent variables. We estimated separate models for all hospital staff, physicians, nurses, hospital senior managers, and frontline staff.

Results:

There was a significant positive association between higher PPR (i.e., lower hospital safety climate) and higher readmission rates for AMI and CHF (P ≤ 0.05 for bath models) but not for pneumonia. The safety climate dimensions “overall emphasis on patient safety” and “unit safety norms” were most strongly correlated with readmission. When stratified by management level, frontline staff perceptions of safety climate were associated with readmission rates for AMI and CHF(P ≤ 0.01), but senior management perceptions were not. Hospitals with a higher PPR among physicians were more likely to experience higher readmission rates after AMI (P ≤ 0.01), whereas hospitals with a higher PPR among nurses were more likely to experience higher readmission rates following CHF exacerbation (P ≤ 0.05).

Conclusions:

Our findings indicate that hospital patient safety climate is associated with readmission outcomes for AMI and CHF. This work supports previously identified differences in senior management and frontline staff perceptions of safety climate and their impact on patient outcomes. Our finding that associations between safety climate and readmission were disease‐ and discipline‐specific may be a result of the different chronologies of the conditions studied, where CHF readmission often represents failure to manage the maintenance of a chronic condition, whereas AMI readmission more often represents the lasting effects of inpatient therapy. Results reveal potential opportunities to target safety improvement initiatives.

Author Disclosure:

L. Hansen, none; S. Singer, none.

To cite this abstract:

Hansen L, Singer S. Hospital Patient Safety Culture and Hospital Readmission. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 60. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/hospital-patient-safety-culture-and-hospital-readmission/. Accessed November 13, 2019.

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