title: Certified Registered Nurse Anesthetist Perceptions of Factors Impacting Patient Safety.
abstract: Certified registered nurse anesthetists (CRNAs) provide more than 40 million anesthetics each year in the United States. This article describes a study that investigates relationships among CRNA organizational structures (CRNA practice models, work setting, workload, level of education, work experience), CRNA ratings of patient safety culture, and CRNA adverse anesthesia-related event (ARE) reporting. This is a cross-sectional survey study of 336 CRNAs randomly selected from American Association of Nurse Anesthetists database. Workload was measured using NASA Task-Load Index and the Revised Individual Workload Perception Scale. Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Overall Perceptions of Safety Scale and Hospital Survey on Patient Safety Patient Safety Grade Scale were utilized to measure safety culture. Dependent variables (ARE) included difficult intubation/extubation, inadequate ventilation/oxygenation, and pulmonary aspiration. The Revised Individual Workload Perception Scale workload was significantly associated with ARE. Years' experience and Patient Safety Grade Scale were inversely associated with ARE. Overall Perceptions of Safety Scale was significantly and inversely associated with ARE. Practice model, education, and work setting were not associated with ARE. Based on findings, CRNA workload, years' experience, and patient safety culture may be important markers for ARE. Administrative interventions designed to upgrade patient safety culture and ensure manageable CRNA workload may foster quality patient care.
authors.affiliation: Acute, Chronic & Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham (Drs McMullan and Shirey); and Center for Healthcare Quality, Rutgers School of Nursing, Newark, New Jersey (Dr Thomas-Hawkins).
authors.forename: Susan P
authors.initials: SP
authors.lastname: McMullan
authors.forename: Charlotte
authors.initials: C
authors.lastname: Thomas-Hawkins
authors.forename: Maria R
authors.initials: MR
authors.lastname: Shirey
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009719:Nurse Anesthetists / Q000523:psychology*; D061214:Patient Safety / Q000592:standards* / Q000706:statistics & numerical data; D010465:Perception; D011795:Surveys and Questionnaires; D016526:Workload / Q000592:standards / Q000706:statistics & numerical data