Pediatrics · Medical Literature
Association between organisational patient safety practices, safety culture and adverse event reporting in paediatric emergency departments in Spain: a multicentre cross-sectional survey study
Abstract
Objectives To analyse the association between organisational patient safety practices, including training in patient safety and clinical simulation, and safety culture and adverse event (AE) reporting in paediatric emergency departments. Design Observational analytical multicentre cross-sectional study. Setting 19 paediatric emergency departments at different levels of healthcare. Participants Healthcare professionals working in paediatric emergency departments. Interventions Not applicable Primary and secondary outcomes Safety culture was analysed using the Hospital Survey on Patient Safety Culture, following the Agency for Healthcare Research and Quality methodology. Logistic regression analyses were performed. Organisational patient safety practices included the presence of patient safety specialists, leadership walkarounds, additional reporting systems and training in patient safety and clinical simulation. Results A total of 1176 professionals participated (response rate 63.8%). The presence of patient safety specialists was associated with more favourable scores in ‘supervisor/manager expectations and actions’, ‘organisational learning’ and ‘teamwork’ (p‘frequency of events reported’ and ‘feedback’ (p Conclusions Organisational patient safety practices were associated with favourable safety culture dimensions. However, after the adjustment, AE reporting was primarily associated with reporting infrastructure and organisational characteristics. The implementation of these practices varied across centres, highlighting differences in the availability of organisational safety practices. Further research is needed to better understand these associations in paediatric emergency departments.
Clinical relevance
Paediatric emergency departments (PEDs) are high-acuity, high-risk environments where adverse event (AE) underreporting and heterogeneous safety cultures are well-documented concerns. This multicentre Spanish study addresses a critical evidence gap by examining whether concrete organisational patient safety practices—including patient safety specialists, leadership walkarounds, simulation-based training, and structured reporting infrastructure—are independently associated with safety culture dimensions and AE reporting behaviour across 19 PEDs. Given wide inter-institutional variability in safety infrastructure and the particular vulnerability of the paediatric population, clinicians and department leaders need actionable data to prioritise resource allocation for safety programmes.
Key findings
1. A total of 1,176 healthcare professionals participated across 19 Spanish PEDs, achieving a robust response rate of 63.8%, lending adequate power for multicentre analyses. 2. The presence of designated patient safety specialists was associated with statistically significantly more favourable scores in three HSOPSC dimensions: 'supervisor/manager expectations and actions promoting patient safety,' 'organisational learning and continuous improvement,' and 'teamwork within units' (p-values reported as significant; specific ORs/CIs not provided in the abstract). 3. Patient safety specialists were also associated with more favourable scores in 'frequency of events reported' and 'feedback and communication about error' (p-values significant; specific effect sizes not reported in the abstract). 4. After multivariable logistic regression adjustment for confounders, AE reporting frequency was primarily associated with the presence of dedicated reporting infrastructure and broader organisational characteristics, rather than with training or simulation programmes alone. 5. Implementation of organisational patient safety practices varied substantially across the 19 participating centres, indicating significant institutional heterogeneity in safety resource availability. 6. NOTE: Specific odds ratios, 95% confidence intervals, p-values, and NNT/NNH were not extractable from the available abstract; quantitative precision is limited by the data provided.
Practice implications
Paediatric emergency department leaders should prioritise the appointment of dedicated patient safety specialists, as this role showed consistent independent associations with multiple favourable safety culture dimensions—including teamwork, organisational learning, and supervisory safety behaviours—suggesting it represents a high-yield structural investment. Establishing or strengthening a formal AE reporting infrastructure (e.g., accessible, non-punitive electronic reporting systems) should be recognised as the primary organisational driver of reporting frequency, and clinical simulation or training programmes, while valuable, should not be considered sufficient substitutes for this infrastructure. Given the wide inter-centre variability in safety practice availability identified in this study, healthcare networks and hospital administrators should conduct systematic safety practice audits across PEDs and benchmark against peer institutions to identify and address gaps in safety governance.