Grant: Partnerships for Health System Improvement (PHSI)

Patient safety depends on a culture of safety and a systematic approach to care. The effect of human factors on patient safety in Intensive Care Units (ICUs) has received little attention. One potentially important component of human factors is moral distress experienced by health care providers. Moral distress is the consequence of being constrained from moving from moral choice to moral action, is associated with burnout and attrition in health care providers, and may contribute to general workplace distress, and to an unsafe work environment and adverse safety events. Due to the nature of the clinical and ethical problems faced by health care providers in ICUs, it is likely that there are relationships among moral distress, general workplace distress, and safety outcomes. We will use validated surveys to measure moral distress and general workplace distress, and objective data collection in ICUs to measure adverse safety outcomes (hospital acquired infections, bleeding while receiving blood thinner medications, hypoglycemia while receiving insulin, and unplanned removal of breathing tubes) and medication safety (medication errors and adverse medication events). Then, we will use statistical techniques to examine the relationships between moral distress and workplace distress on one hand, and these safety/medication outcomes on the other. We will present our findings to both academics and decision-makers in the health care system. Understanding the magnitude of moral distress and general workplace distress in ICUs will point to opportunities for improvement in the workplace. If we find relationships between these measures and adverse patient safety and medication safety outcomes, the imperative for making these improvements will be highlighted even more.