Cultural transformation beyond checklists for patient safety: a longitudinal evaluation of safety interventions in critical care

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BACKGROUND: Implementing structured safety interventions in intensive care units (ICUs) remains challenging due to patient complexity, staff turnover and dynamic workflows. This study evaluates the longitudinal impact of a multidisciplinary safety improvement programme in a high-acuity ICU. METHODS: A 2-year prospective evaluation was conducted in a 12-bed academic ICU in Milan, Italy. The Hospital Survey on Patient Safety Culture was administered to all ICU professionals (physicians, nurses, physiotherapists) in December 2022 and repeated in December 2024. Interventions included staff training, enhanced event reporting systems, regular morbidity and mortality conferences and a multidisciplinary safety team. Responses were analysed descriptively, including subgroup analysis by professional category and staff turnover. RESULTS: A total of 86 staff completed the 2022 survey, and 66 completed the 2024 survey, with 56 participating in both. Over the 2 years, perceptions of teamwork (68%-81%), communication openness (47%-60%) and comfort in reporting errors (38%-55%) showed substantial improvement. The proportion of staff who perceived management support for safety increased from 70%-80%. Staff hired after 2022 reported more favourable safety perceptions than continuing staff, particularly in communication and reporting domains. CONCLUSIONS: Structured, multidisciplinary interventions led to measurable improvements in ICU safety culture. However, persistent interprofessional differences and under-reporting of adverse events highlight the need for targeted strategies. Safety culture transformation requires sustained leadership, continuous onboarding and system-focused feedback mechanisms to ensure long-term impact.

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