Implementing successful interventions to support effective medication reconciliation is an ongoing challenge. The MARQUIS2 study examined whether system- and patient-level interventions plus physician mentors can improve medication reconciliation and reduce medication discrepancies. This analysis based on patient exposure in the MARQUIS2 study found that patient receipt of a best possible medication history (BPMH) in the emergency department and medication reconciliation at admission and discharge were associated with the largest reductions in medication discrepancy rates.

… research on this relationship is warranted. … Casalino LP, Li J, Peterson LE, et al. Relationship between physician …

Medication reconciliation aims to prevent adverse events during transitions of care, but implementing effective interventions supporting medication reconciliation has proven challenging. Building upon lessons learned in the MARQUIS1 study, this pragmatic quality improvement study (MARQUIS2) implemented a refined toolkit including system-level and patient-level interventions as well as physician mentors providing remote coaching and in-person site visits. Across 17 hospital sites, the intervention was associated with a significant decrease in unintentional mediation discrepancies over time.

… professional categories . … O'Leary  KJ, Manojlovich M, Johnson JK, et al. A multisite study of interprofessional …

Artificial intelligence may have the potential to improve patient safety by enhancing diagnostic capability. In this study, researchers applied machine learning techniques to a large amount of pediatric electronic health record data and found that their model was able to achieve diagnostic accuracy analogous to that of skilled pediatricians.

Previous studies have investigated the benefits of unit-based interventions as a potential safety strategy. This survey study sought to examine implementation of several unit-based initiatives to improve care quality in inpatient settings: localization of physicians to specific designated units, nurse–physician joint leadership, periodic review of local performance data, and interdisciplinary rounds. Investigators invited residency program directors and hospital medicine leaders to participate in the study. The response rate was low and thus the findings may not reflect academic hospitals in general. Overall, among respondents' institutions, the interventions were not widely or consistently implemented. These findings underscore the challenge of translating interventions shown to be effective for enhancing safety in research settings into clinical practice.

Fragmented care transitions may lead to adverse events due to poor provider communication, disjointed continuation of care, and incomplete patient follow-up. In this study, site visits were conducted at 22 healthcare organization across the United State to determine facilitators and barriers to implementing transitional care services. Identified facilitators included collaborating within and beyond the organization, tailoring care to patients and caregivers, and generating buy-in among staff. Barriers included poor integration of transitional care services, unmet patient or caregiver needs, underutilized services, and lack of physician buy-in. Results suggest how institutions may wish to prioritize strategies to facility effective care transitions.

This retrospective cohort study demonstrated that a readmission risk score could prospectively identify patients at risk for readmissions for the four target conditions for nonpayment: acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and heart failure. These results suggest that this algorithm can identify a high-risk patient group who may benefit from interventions to prevent readmission.

Hospitals with high readmission rates face reductions in Medicare reimbursements. Understanding the patient perspective at the time of readmission may better inform future readmission reduction efforts. Researchers surveyed patients readmitted to the general medicine services within 30 days of discharge across 12 hospitals on multiple aspects of self-care. Although 91% of patients reported understanding of their discharge plan, more than 52% reported difficulty with at least one aspect of self-care after discharge.

Given that hospitalized patients require 24-hour access to clinicians, management of fatigue due to shift work is an important consideration for overnight care teams. Discussing the physiological impacts of working during typical sleep time, or circadian misalignment, this review explores on-site naps, appropriate caffeine intake, and light exposure as techniques hospitalists can utilize to manage the negative effects associated with sleep disruption. A PSNet perspective described how fatigue can affect physician performance.

Preventing readmissions is a cornerstone of patient safety efforts. However, one concern about nonpayment for readmissions is that many may not be preventable. To determine whether they were preventable, this observational study investigated readmissions through patient and physician surveys along with chart review. Researchers determined that only one quarter of readmissions were preventable. Factors associated with potential preventability were premature hospital discharge, insufficient communication with outpatient providers, failure to discuss care goals, and emergency department decisions to readmit a patient who did not require a second inpatient stay. These results suggest that multiple interventions will be needed to avert readmissions, and such efforts will have limited impact since most readmissions are not preventable.

Medication errors are a common cause of adverse events after hospital discharge. This randomized controlled trial found that integrating pharmacists into the discharge process improved patient satisfaction and reduced adverse drug events, emergency department visits, and readmissions in the 30 days after discharge. Pharmacists conducted medication reconciliation, provided patient education, and had multiple telephone contacts with patients after discharge.

Root cause analyses (RCAs) are widely employed at hospitals for exploring safety events. However, RCAs may not always be effective, and recent guidelines issued by the National Patient Safety Foundation highlighted the importance of emphasizing actions to address root causes. This study describes the development of a new rapid approach to RCAs, colloquially called "SWARMing," based on the concept of swarm intelligence. SWARMs are conducted without delays after a reported event. The process begins with a preliminary investigation into what happened and who was involved, followed by an in-person meeting with an interdisciplinary team and any staff directly involved in the event. The authors describe the key structure and steps of their SWARM program, including the focus on actions and accountability. Following the implementation of SWARMs, incident reporting increased by 52%. At the same time, the observed-to-expected mortality ratio decreased 37% from 1.2 to 0.7 across the health system, suggesting the program had a significant effect.

Clinician discontinuity is often cited as a potential patient safety issue. However, this study found that transfers of care between hospitalists did not appear to be associated with adverse events. The authors note that as hospital care is provided within teams, research should focus on the effects of team complexity and changes on patient safety.

Hospital readmissions have received intensive focus lately, largely compelled by Medicare's expanded financial penalties for excessive readmission rates. This study reviewed 30-day readmissions following surgery at hospitals enrolled in the National Surgical Quality Improvement Program. Nearly half a million operations were included, with an overall readmission rate of 5.7%. Following lower extremity vascular bypass, approximately 1 in 7 patients were readmitted. Surgical site infections accounted for the largest proportion of overall readmissions. It is notable that only 2% of patients were readmitted for the same complication that prompted their index admission, further confirming that surgical readmissions are overwhelmingly due to new complications arising from the procedure. In an accompanying editorial, Dr. Lucian Leape notes that analyses of these surgical complications can serve as "treasures" for providing important lessons for improvement, and he calls for a 50% reduction in surgical complication rates in the near term.

This qualitative study of a large-scale quality improvement effort to reduce readmissions and adverse events after discharge identified numerous barriers to implementing the project as well as several facilitators of success. Intensive mentoring by project champions appeared to be a key factor in success of the program.

Care transitions are a vulnerable time for patients as they move through various levels of care. Exploring factors that hinder safety during transitions, this review describes successful improvement initiatives and offers strategies to reduce readmissions, such as enhancing team communication, educating staff, and standardizing transition plans.

An educational program that included lectures, ward-based teaching sessions, and protocols significantly decreased the rate of intravenous medication errors in an intensive care unit in Vietnam. However, clinically significant errors still occurred in nearly half of all medication administrations (down from 64% pre-intervention).

Hospitals that participated in Project BOOST, a national quality improvement collaborative for preventing readmissions, appeared to have slightly lower 30-day readmission rates.