Patient safety attitude among intensive care unit physicians and nurses: a multi-center study in Egypt

Continuous safety culture assessment, especially in high-risk areas as the intensive care unit (ICU) is one of the requirements for patient safety. This study aimed to assess patient safety attitude in the intensive care units of four public hospitals in Egypt, compare it with benchmarking data, and identify opportunities for improvement.

A cross-sectional design was used. The Safety Attitudes Questionnaire (SAQ) was distributed in March 2024 to a total of 543 physicians and nurses involved in direct patient care in eight ICU of four public hospitals. A response rate of 85% was achieved (65.12% for physicians and 89.28% for nurses). Safety culture score (ranges from 0 to 100) and percent-positive scores (percentage of respondents with a mean score of > 75 where 100 is best) were calculated according to the tool scoring key. The scores were also compared with the benchmarking scores.

The overall mean scale score was 63.7 ± 13.4 and the percentage of positive responses was 58.1%. Job satisfaction was the dimension with the highest total mean and percentage of positive responses (70.0 and 65.1%, respectively). On the other hand, stress recognition was the dimension with the lowest mean score and percentage of positive responses (59.4 ± 23.8 and 53.6%, respectively). Physicians attained a significantly higher total mean scale score for the teamwork climate, job satisfaction, perceptions of management and work conditions dimensions compared to nurses (73.8 ± 10.4, 81.7 ± 14.6, 72.5 ± 19.4, 70.6 ± 18.1 for physicians compared to 61.0 ± 15.4, 68.4 ± 23.0, 60.8 ± 22.4, 61.8 ± 22.3 for nurses, respectively) (p < 0.05) while "stress recognition'' was significantly higher among nurses (mean scale score for nurses was 60.4 ± 23.6, p < 0.05 compared to 52.0 ± 24.0, p < 0.05 for physicians). The dimensions "teamwork climate'', "safety climate'' and "stress recognition'' attained lower scores in the current study compared to the benchmark data.

The dimensions "teamwork climate'', "safety climate'', and "stress recognition'' attained relatively low scores which calls for interventions such as team trainings, limitation of work hours and senior executive safety rounds. Physicians had significantly higher scores than nurses in four out of six domains which needs further research to identify the reasons and plan the appropriate improvement strategies. Future studies should track changes over time.