Patient access to electronic health records can improve engagement in care. This qualitative study involving patients and staff at general practices in the United Kingdom highlighted unintended consequences of online access to health records, including challenges with patient health literacy, decreased quality of documentation, and increases in staff workload.

The UK’s National Health Service (NHS) is increasingly using digital technology to deliver care. Researchers interviewed 19 patients and 18 general practice staff about their experiences with one of the NHS’s digital tools, online (asynchronous) consultations. Unintended consequences related to access to and efficiency of care are discussed.  

Patients with cancer are at increased risk of medication errors in both the inpatient and outpatient settings. In this study, investigators solicited input from cancer care clinicians regarding their perception of causes and potential solutions for medication errors. Clinicians identified limited health literacy and inadequate information sharing among clinicians as barriers to providing safe care and they suggested increased patient engagement as one potential approach to improving safety.

Medication errors remain a significant source of patient harm. Although many studies have focused on the hospital setting, less is known about ambulatory medication safety. In this study, primary care physicians were asked to identify three significant problems and solutions regarding medication errors in the outpatient setting. Investigators used an innovative approach to rank the problems and solutions described by the 113 clinician respondents in the study. The top three problems identified included incomplete medication reconciliation during a transition in care, insufficient education provided to patients on their medications, and inadequate discharge summaries. Standardizing discharge summaries, decreasing unnecessary prescribing, and avoiding polypharmacy were the three highest ranked solutions. A previous PSNet perspective discussed safety in ambulatory care.

Compared with other patient safety issues, diagnostic errors have received little attention until recently. Missed or delayed diagnoses are a common reason for malpractice claims. This study sought to determine barriers and solutions to delays in diagnosis in primary care. Investigators sent a questionnaire to more than 500 clinicians and received 113 responses. Participants identified 33 discrete problems associated with delays in diagnosis and suggested 27 solutions. The main issues included inability to meet patients' care needs and inadequate communication between secondary and primary care. The top solutions included improving training of primary care doctors and enhancing communication among providers as well as between providers and patients, especially around test results. An Annual Perspective discussed diagnostic errors in more detail.

The landmark Keystone ICU study, which achieved remarkable sustained reductions in central line–associated bloodstream infections in intensive care unit (ICU) patients, stands as one of the most prominent successes of the patient safety field. Although the use of a checklist gathered the most publicity, the study's key insight was that preventing health care–associated infections (HAIs) required extensive attention to improving safety culture by addressing the socioadaptive factors within hospitals that contributed to HAIs. In this new AHRQ funded national study, the Comprehensive Unit-based Safety Program was implemented at 603 hospitals in 32 states, with the goal of preventing catheter-associated urinary tract infections in ICU and ward patients. The effort involved socioadaptive interventions (various approaches shown to improve safety culture) and technical interventions (targeted training to reduce usage of indwelling urinary catheters and providing regular data feedback to participating units). Catheter usage and infection rates significantly decreased in ward patients, although no change was found in ICU patients. This study thus represents one of the few safety interventions that has achieved a sustainable improvement in a clinical outcome. An earlier article described the implementation of the program, which involved collaboration between state and national agencies and academic centers. In a 2008 PSNet interview, the study's lead author discussed his work on preventing HAIs.

The continued progress in eliminating central line–associated bloodstream infections (CLABSIs) in intensive care units (ICUs) stands as one of the patient safety movement's major successes. The initial efforts to prevent CLABSI in the ICU at Johns Hopkins Hospital, championed by Dr. Peter Pronovost, were subsequently replicated in the landmark Keystone ICU project in Michigan. This study describes the results of an AHRQ-funded effort to extend the Keystone ICU approach nationwide, attempting to prevent infections in more than 1000 ICUs in 44 states. The initiative, which combined the well-publicized infection control checklist with interventions to enhance safety culture (such as the comprehensive unit-based safety program) and continuous data measurement and feedback, achieved a reduction in CLABSI rates of more than 40%. This remarkable series of interventions exemplifies the value of using a sociotechnical approach to improving safety and has likely saved thousands of lives.

Although direct communication of results to patients via email has been proposed as a strategy to prevent failure to follow up on test results, this systematic review did not find any controlled studies evaluating the effectiveness of this approach.

Rapid adoption of digital health care technologies ("eHealth") to improve the quality and safety of care continues at an unprecedented pace. While many eHealth technologies require substantial investment, their adoption is often justified by beliefs that they support efficient and cost-effective care. Research focusing on different eHealth strategies, such as computerized provider order entry, electronic health records, e-prescribing, and clinical decision support systems, continues to grow. This study conducted a systematic review of 53 past systematic reviews assessing the impact of eHealth technologies. Investigators found that most clinical claims made about commonly used technologies were not substantiated by empirical evidence. Furthermore, their findings suggest poor grounds for arguing cost-effectiveness and raise additional concerns about the unintended risks introduced by new technologies. The authors advocate for continued vigilance in evaluating eHealth as a tool to improve patient care, including thoughtful incorporation of these evaluations into policy decisions and spending. A past AHRQ WebM&M interview discussed computerization in health care.