Is culture associated with patient safety in the emergency department? A study of staff perspectives.

Objective: To describe the patient safety culture of Dutch emergency departments (EDs), to examine associations between safety culture dimensions and patient safety grades as reported by ED staff and to compare these associations between nurses and physicians.

Design: Cross-sectional survey conducted in 2007.

Setting: Thirty-three non-academic EDs in the Netherlands.

Participants: Four hundred and eighty nurses, 159 physicians and 91 other professionals.

Main Outcome Measure: Self-reported level of patient safety.

Results: In unadjusted analyses, all dimensions of safety culture were positively associated with the reported level of patient safety and six of these associations with patient safety were statistically significant after adjustment ('teamwork across units', 'frequency of event reporting', communication openness', 'feedback about and learning from errors', 'hospital management support for patient safety'). Differences between nurses and physicians were found on two dimensions ('frequency of event reporting' and ' hospital management support for patient safety'). Physicians tended to grade patient safety higher than nurses whilst having equal judgements on these two dimensions.

Conclusions: Staff identified several dimensions of safety culture that are associated with staff-reported safety in the ED. Physicians and nurses identified distinct dimensions of safety culture as associated with reported level of patient safety.