Fostering safer intensive care units: How incident reporting drives cultural change

Patients admitted to intensive care units (ICUs) are more prone to patient safety incidents (PSIs), with substantial negative effects. Patient safety culture (PSC) is seen as a crucial pillar to address these safety problems. The aim of our study was to evaluate the impact of the implementation of a PSIs reporting system on PSC in ICUs.

We conducted a quasi-experimental study in 15 ICUs in two Tunisian university hospitals. One hospital was chosen as the intervention site (10 ICUs), where a PSI reporting system was implemented, while the other served as the control (five ICUs). All 344 ICU professionals were invited for study participation (i.e., physicians, ICU specialised nurses, registered nurses, and nursing assistants). The primary outcome was the change in PSC dimensions, all assessed with the validated French version of the Hospital Survey on Patient Safety Culture. Two-way multivariate analysis of variance was used to determine trend changes in mean PSC dimension scores.

During baseline assessment (M1), 284 professionals responded (167 in the intervention group and 117 in the control group). After the intervention, five PSC dimensions improved significantly in the intervention group: "Frequency of adverse events reported" (from 20.8% to 37.6%, p < 0.001), "Continuous improvement and organisational learning" (35.9%-48.3%, p < 0.001), "Teamwork within units" (47.3%-59.8%, p < 0.001), "Communication openness" (21.4%-36.4%, p < 0.001), and "Non-punitive response to error" (20.8%-38.5%, p < 0.001).

The findings provide important insights into how structured reporting systems can enhance PSC in resource-limited healthcare settings. Although the study was conducted in a single intervention site using a quasi-experimental design, the results remain valuable in highlighting viable strategies for safety improvement and may guide future larger-scale and multisite evaluations. Targeted reporting interventions can significantly improve PSC in ICUs, even within resource-constrained settings. Lasting impact requires structured monitoring to sustain and optimise these improvements.