Patient safety and medical errors: knowledge, attitudes and behavior among Italian hospital physicians.

Objective: To investigate physicians' knowledge about evidence-based patient safety practices, their attitudes on preventing and managing medical errors and to explore physicians' behavior when facing medical errors.

Design: A nationwide cross-sectional survey.

Setting: We first stratified our population by the 20 Italian regions. Then, within each stratum, we selected by simple random sampling, for each region, one regional general hospital and one district general hospital to yield a sample of 40 hospitals overall.

Participants: Twelve hundred physicians involved in direct patient care (30 per hospital) were sent a survey by mail and 696 responded.

Main Outcome Measures: Knowledge on patient safety practices, attitudes and practices toward the prevention of medical errors.

Results: Physicians' knowledge of evidence-based safety practices was inconsistent. More than 90% of physicians reported that counting surgical items during an invasive surgical procedure represented a patient safety practice. Positive attitudes about patient safety were revealed by responses, but 44.5 and 44.1%, respectively, agreed or were uncertain about the disclosure of errors to the patients. The pattern of behavior showed that 7.6% of physicians reported to have never been involved in medical errors, and among system failures, 'overwork, stress or fatigue of health professionals' was the most highly rated item.

Conclusions: The results from our study highlight that greater efforts are needed to facilitate the translation of positive attitudes towards patient safety into appropriate practices that have proven to be effective in the reduction of medical errors.