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.

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.

Teamwork is essential to providing high quality, safe healthcare. This survey of general medicine nurses, nurse assistants, and physicians at four hospitals identified significant differences in perceptions of teamwork climate and collaboration across professional categories. While a majority of physicians reported the quality of collaboration with nurses as high, less than half of nurses gave high ratings to the quality of collaboration with physicians. Future teamwork training efforts should target the discrepancy in perceived teamwork across professional categories.

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … Previous studies have investigated the …

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.

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … Root cause analyses (RCAs) are widely …

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.

… Southern medical journal … South Med J … This qualitative study of a large-scale quality …

… Cleveland Clinic journal of medicine … Cleve Clin J Med … Care transitions are a vulnerable time for patients …

… Journal of hospital medicine … J Hosp Med … Hospitals that participated in Project BOOST , a …

This commentary describes a medication reconciliation improvement toolkit, along with results and lessons learned from implementing the strategy.

… Journal of hospital medicine … J Hosp Med … This study found generally high teamwork scores …