"Put on your own mask first"

I was traveling over the Thanksgiving holidays, and one of the flight attendant's instructions struck me, as it always does: "Put on your own mask before assisting others."  Basically, if there is a sudden cabin depressurization and the oxygen masks drop from the compartment above, passengers should place their own mask before helping others (e.g. a child sitting in the next seat).  It's become a great metaphor for the linkage between patient safety and staff safety.  If the hospital staff feels safe, they will be in a much better position to keep their patients safe.

While it is commonly accepted that the safety of the patient and provider are inextricably linked, there is surprisingly little, if any, data to support this statement.  The research in this area that has been done relies on safety culture data as a proxy measure for employee safety, which may not be valid.  With this in mind, one of my former colleagues at Cincinnati Children's Hospital Medical Center reviewed over 2 years worth of hospital patient and safety data for 25 patient care units (grouped into intensive care units (ICUs), medical/surgical units, and psychiatry units) (see Dr. Nancy Daraiseh's study, "Patient and employee safety events - are they related by common hospital unit factors?").  Dr. Daraiseh's research team also considered the relationship between safety events and five hospital metrics of staffing, occupancy, and patient acuity.

Contrary to expectations, patient and employee safety events showed very little correlation, with inpatient units having higher rates in one category (e.g., patient safety) often showing lower rates in the other (e.g. employee safety).  What was not surprising (at least to me), the highest patient safety event rates were found in the ICU's, psychiatry/medical (an inpatient psychiatry unit for patients with medical co-morbidities), and the complex airway/pulmonary unit.  In other words, patients who were either very complex or critically ill had the highest rate of patient safety events.  Conversely, the highest employee safety event rates were found in the psychiatry units and were most commonly due to patient aggression and/or injury by the patient.  Some of the commonly cited risk factors for safety events (high unit occupancy, low staffing, or high patient acuity) were significantly associated with patient safety events.  However, the relationship between these hospital metrics and employee safety events was weaker and not significant.  

I still believe that there is a connection between patient safety and employee safety.  As Dr. Daraiseh writes, "A safe and healthy worker can provide safe, exemplary patient care."  She goes on to write that "addressing each [patient safety and employee safety] separately can result in duplication of effort and missed opportunities.  By unifying efforts, health care organizations can improve patient outcomes while fostering an environment in which workers are unharmed."  I couldn't have said it better myself...