Discordance in OR Safety Attitudes: Does Safety Lie in the Eye of the Beholder?
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BACKGROUND: Efforts to improve operating room (OR) safety can be optimized if we understand the safety attitudes of those who work in the OR. We sought to describe the safety attitudes of current OR personnel. METHODS: Survey: The Safety Attitudes Questionnaire (OR Version) was modified to develop a shorter, 23-item anonymous electronic survey to measure attitudes toward OR safety. Respondents were also asked to rate the quality of their communication with other providers who care for surgical patients. Participants: Surgeons and proceduralists, anesthesia providers, and nurses who worked in perioperative services and on the surgical wards. Data: Respondents' demographic information was collected. Survey responses were on a 5-point Likert scale, where a higher score reflected a better safety attitude or higher quality communication, as appropriate. Analysis: Classical test theory and factor analysis. ANOVA was used to compare responses between surgeons/proceduralists, anesthesia providers and nurses. Results are reported as mean (SD). RESULTS: Survey: The 23 survey items reliably measured attitudes toward OR safety (α=0.92). Respondents: 170 staff responded to the survey (55 surgeons, 29 anesthesia providers, and 86 nurses). Mean age of respondents was 40.1 (10.9) years. Median duration of experience was 8 years (range: <1 to 42). Attitudes toward OR safety culture: The mean score on the 23-item survey for all respondents was 3.95(0.68). Scores differed significantly among provider groups (p=0.0009). Surgeons' mean score was 0.57 higher than anesthesia providers' (p<0.05), and 0.33 higher than nurses' (p<0.05). Quality of communication: The surgeons' perception of the quality of their communication with nurses was higher than the nurses' perception of the quality of their communication with surgeons (3.95 vs. 3.05, p<0.0001). Similarly, surgeons' perception of the quality of their communication with anesthesia providers was higher than the anesthesia providers' perception of their communication with surgeons (4.43 vs. 3.81, p=0.0015). However, the anesthesia providers' perception of the quality of their communication with nurses did not differ from the nurses' perception of the quality of their communication with anesthesia providers (3.62 vs. 3.68, p=0.77). CONCLUSION: The abbreviated questionnaire is a reliable measure of OR safety attitudes. Surgeons had the most positive OR safety attitude, but there was consistent discrepancy in the way surgeons rated their communication with other provider groups - surgeons reported that the quality of their communication with anesthesia providers and nurses was better than how these other groups rated their communication with surgeons. This finding calls to question the validity of the surgeons' survey scores, and whether they truly had the best safety attitude.