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What’s New this Week
The latest annotated links to patient safety literature, news, and more.
Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis.
Attenello FJ, Wen T, Cen SY, et al. BMJ. 2015;350:h1460.
Intended and unintended effects of large-scale adverse event disclosure: a controlled before-after analysis of five large-scale notifications.
Wagner TH, Taylor T, Cowgill E, et al. BMJ Qual Saf. 2015;24:295-302.
Errors upstream and downstream to the Universal Protocol associated with wrong surgery events in the Veterans Health Administration.
Paull DE, Mazzia LM, Neily J, et al. Am J Surg. 2015 Mar 21; [Epub ahead of print].
Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute.
Simons PAM, Houben R, Vlayen A, et al. Eur J Oncol Nurs. 2015;19:29-37.
Association of face-to-face handoffs and outcomes of hospitalized internal medicine patients.
Schouten WM, Burton CM, Jones LD, Newman J, Kashiwagi DT. J Hosp Med. 2015;10:137-141.
Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital.
Bonafide CP, Lin R, Zander M, et al. J Hosp Med. 2015 Apr 15; [Epub ahead of print].
Implementation of a surgical safety checklist and postoperative outcomes: a prospective randomized controlled study.
Chaudhary N, Varma V, Kapoor S, Mehta N, Kumaran V, Nundy S. J Gastrointest Surg. 2015;19:935-942
What to expect when you're evaluating healthcare improvement: a concordat approach to managing collaboration and uncomfortable realities.
Brewster L, Aveling EL, Martin G, Tarrant C, Dixon-Woods M; Safer Clinical Systems Phase 2 Core Group Collaboration & Writing Committee. BMJ Qual Saf. 2015;24:318-324.
Elucidating reasons for resident underutilization of electronic adverse event reporting.
Hatoun J, Suen W, Liu C, et al. Am J Med Qual. 2015 Mar 9; [Epub ahead of print].
Service members are left in dark on health errors.
LaFraniere S. New York Times. April 19, 2015.
South Carolina medication error bill is dangerously off target.
ISMP Medication Safety Alert! Acute Care Edition. April 9, 2015;20:1,4.
Isolation precautions for visitors.
Munoz-Price LS, Banach DB, Bearman G, et al. Infect Control Hosp Epidemiol. 2015 Apr 10; [Epub ahead of print].
Save the Date. AHRQ Research Conference Returns!
Agency for Healthcare Research and Quality and AcademyHealth. October 4–6, 2015; Crystal Gateway Marriott Hotel and Convention Center, Crystal City, VA.
From Med Wreck to Med Rec: Results, Lessons Learned, and Implications of the MARQUIS Trial.
National Patient Safety Foundation. May 26, 2015; 2:00–3:00 PM (Eastern).
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Also of Note...
Sentinel Event Statistics 1995–2014.
The Joint Commission.
The 17th Annual NPSF Patient Safety Congress.
National Patient Safety Foundation. April 29–May 1, 2015; JW Marriott Austin, Austin, TX.
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2014 Annual Perspectives
By Urmimala Sarkar, MD, and Kaveh Shojania, MD
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