The "Staff Competency and Performance" and "Environmental Factors" were the most contributory factors of SEs in the number of significant correlations with the patient safety culture domains. Multivariate analyses showed that “Handoffs and Transitions”, “Nonpunitive Response to Error”, and “Teamwork Within Units” domains were significant predictors of the number of SEs. The correlation analysis performed on 89 Saudi hospitals showed that higher positive patient safety culture scores were significantly associated with lower rates of reported-SEs in 3 out of the 12 domains, which are “Teamwork Within Units”, “Communication Openness”, and “Handoffs and Transitions”. The highest numbers of reported-SEs in 103 hospitals were related to the contributory factors of “Communication and Information” (63.20%) and “Staff Competency and Performance” (61.04%). The highest positive domain scores in patient safety culture domains in the Saudi hospitals ( n = 366) were “Teamwork Within Units” (80.65%) and “Organizational learning-continuous improvement” (80.33%), and the lowest were “Staffing” (32.10%) and “Nonpunitive Response to Error” (26.19%). To explore the relationships between patient safety culture and reported-SEs rates, we performed descriptive statistics, a test of independence, post-hoc analysis, correlation analysis, and multivariate regression and stepwise analyses. We utilized two data sources (the reported-SEs and the patient safety culture survey) that were linked using hospitals information. This study aimed to explore the relationships between the patient safety culture and the reported-SEs on a national level during the year 2020 in Saudi hospitals. To our knowledge, limited studies explored the relationships between patient safety culture and sentinel events on a local level and no research has been conducted at the national level in Saudi Arabia. To minimize the fear of sentinel events reporting and the occurrence of sentinel events, patient safety culture improvements within healthcare organizations is needed. Sentinel events (SEs) can result in severe and unwanted outcomes.
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