[Safety Walkround as a risk assessment tool: the first Italian experience]

In 2007 the Study Group "Clinical Risk Management" of the Italian Society of Anaesthesia and Intensive Care Unit (SIAARTI) performed a multicentric study in Intensive Care Unit (ICU) to assess the feasibility and efficacy of the Safety WalkRound (SWR) as a tool for the risk assessment. As the environment and organization of ICU are more complex than anaesthesia ones, mainly due to the severity of patients, high number of involved healthcare givers and different kinds of procedures, the Study Group decided that a check list is not fit for ICU and , after a careful review of the literature, chose to test the Safety WalkRound. in four Italian General ICUs. The SWR was born in 2003 when Frankel plans a structured interview of 15 questions (about 50% open) to collect operators' opinion about rate and type of errors, near misses, communication, problems regarding the report of adverse events and suggestions to increase patient safety. Consequently SWR is a tool of risk assessment alternative to the Incident Reporting which is marked by a diffuse underreporting of operators. Although the SWR is a new tool not validated in Italian language neither published in Italy on PubMed journals , the Study Group has decided that it might be fit for the organization of Italian Healthcare System. A back translation of the validated model of Joint Commission was provided and the translated version has been lightly changed to be employed in hospitals with and without Incident Reporting . The questions have been changed or introduced on the basis of the organization vulnerabilities detected with observational techniques or Focus Group. The interview performed in Italy contains 16 questions classified into five groups: a) error, b) error prevention, c) communication, teamwork and leadership, d) error discussion and e) relationship with patients and their families. The answers collected have been analyzed to detect the vulnerabilities in the organizations and specify the improvements to implement in every ICU. A statistical analysis was performed to verify the correlation between the answers collected and the results of the other techniques of risk assessment previously used ( observations and Focus Group ) . The value of k Pearson found ( mean value 0,976) has demonstrated this correlation and the efficacy of SWR in detecting system vulnerabilities already found with the other assessment techniques. The value of a Cronbach ( mean value 0,798) has demonstrated an internal consistency reliability. The results of this study have demonstrated that the Italian translation is fit for the model by Frankel and makes available a lot of information useful to improve patient safety. The study has demonstrated the sensibility, efficacy and efficiency of this tool in detecting the vulnerabilities in every ICU of the four ones. SWR is marked by feasibility, high compliance of operators and low costs; besides increases safety culture in the staff and demonstrating.