Perceptions of risk to patient safety in the pediatric ICU, a study of American pediatric intensivists

► Pediatric intensivists have varied attitudes about risks to patient safety. ► Risks judged most frequent are not the same risks judged to be most problematic. ► Perceived frequency and problem score for most risks are inversely related. ► Exceptions are hand hygiene and central line infections. There is no study yet of the perception of risk in pediatric intensive care unit (PICU) physicians. The purpose of this study is to characterize these perceptions with respect to frequency and importance. The study is a cross sectional survey of physician members of the Society of Critical Care Medicine who report caring for critically ill children. Perceived frequency and importance of risks to patient safety across 11 domains in the pediatric ICU was obtained through a validated survey. Mean problem score was tested for trend across frequency categories. 140 responses were obtained from 199 opened email invitations (73%) and 822 total emails (17%). The survey was internally valid with a Cronbach alpha value of 0.87. The most frequent risks to patient safety occurred in areas of ineffective communication, inadequate training and orientation, and poor hand hygiene. The most problematic risk domains were ineffective communication, healthcare acquired infections, inadequate training and orientation, and medication error. For most risk categories, as the perceived risk frequency increased, the mean perceived problem score of that risk decreased, excepting hand hygiene (p=0.96) and central line infections (p=0.27). Risks related to communication, training and orientation, and hand hygiene are perceived as frequent. Risks related to communication, healthcare acquired infections, training and orientation, and medication errors are perceived as the most important. Variance in attitude toward these risks is significant for most domains. Understanding variance will be important in changing human behavior related to risk in the PICU.