… Jt Comm J Qual Patient Saf … Organizations such as The Joint … validation of a brief culture-of-safety survey. Jt Comm J Qual Patient Saf. Epub 2022 Apr 28. doi: 10.1016/j.jcjq.2022.04.006 …

Alarm fatigue is a pervasive contributor to distractions and error. This discussion examines how, while minimizing nuisance alarms is important, those efforts need to be accompanied by safety culture enhancements to realize lasting progress toward alarm reduction.

Surgical safety has made advances while new difficulties continuously emerge. This article suggests that the specialties capitalize on artificial intelligence and professional wellness as two avenues to generate sustainable safety progress.

Rapid response teams (RRTs) are intended to quickly identify clinical deterioration and prevent intensive care unit transfer, cardiac arrest, or death. This article summarizes the evidence included in the AHRQ Making Healthcare Safer III report about the use of RRTs to decrease failure to rescue. Although utilization is widespread, the authors conclude that definitive evidence that RRTs are associated with reduced rates of failure to rescue is inconclusive. The authors note that evidence does support that RRTs are associated with reduced secondary outcomes, such as ICU transfer rate and cardiac arrest.

The Hospital Star Rating system was implemented in 2016 to aid patients in identifying safe, high-quality hospitals. The system has evolved over time to address applicability concerns. This commentary highlights changes in the latest reiteration of the program and discusses challenges in its use.

… Jt Comm J Qual Patient Saf … Postoperative complications can increase … with the lowest cost per event. … Merkow RP, Shan Y, Gupta AR, et al. A comprehensive estimation of the costs … actual costs from multiple, diverse hospitals. Jt Comm J Qual Patient Saf. 2020;46(10):558-564. …

This study examined variation in operative technical skills among patients undergoing colorectal and non-colorectal procedures and the association with patient outcomes. Higher technical skills were significantly associated with lower rates of complications, unplanned reoperations, and death or serious morbidity. The findings suggest that this skill variation accounts for more than 25% of the variation in patient outcomes.

… and reduction in communication breakdowns. … Yuce TK, Yang AD, Johnson JK, et al. Association between implementing …

This mixed-methods study analyzed data from a survey of general surgery residents and qualitative interviews with residents and program directors participating in the FIRST trial to assess preparedness for surgical residents. Results indicate the lack of preparedness was associated with inadequate exposure to resident responsibilities while in medical school, such as infrequent overnight calls or not completing a subinternship. Preparedness was associated with a nearly two-fold lower risk of experiencing burnout.

In this survey of 6,264 US general surgery residents, 70% reported experiencing at least one bullying behavior during surgical training and 18% reported frequent bullying. The most common types of bullying behavior were repeated reminders of mistakes, being shouted at, withholding of important information, persistent criticism, and hostility. Women and racial/ethnic minorities reported more frequent bullying. Residents reporting frequent bullying had higher rates of burnout, suicidal thoughts, and thoughts of leaving surgical training.

This cross-sectional survey of general surgery residents to assessed resident wellness and self-reported error and compared these results against National Surgical Quality Improvement Program (NSQIP) registry data to assess patient outcomes. Over a six-month period, 22.5% of residents self-reported a near-miss medical error and nearly 7% reported an error resulting in patient harm. Residents reporting harmful medical errors were more likely to report symptoms of burnout and poor psychiatric well-being, but researchers did not find any significant association between well-being and adverse postoperative patient outcomes reported in the NSQIP registry.

… N. Engl. J. Med. … New Engl J Med … Physician burnout  can negatively impact not only …

This retrospective study of cancer care safety examined the extent to which patients received recommended chemotherapy. A significant proportion of breast, lung, and colorectal cancer patients did not receive chemotherapy; patients who were black and those lacking health insurance or covered by Medicaid were at higher risk. There was marked variability in chemotherapy delivery by location and hospital. The authors conclude that failure to administer chemotherapy is a significant safety gap that should be addressed.

… Journal of the American College of Surgeons … J Am Coll Surg … Establishing a strong culture of safety is …

Prior studies have found that patients are often prescribed opioids inappropriately after undergoing surgery. This qualitative study reports on the implementation of a multifaceted effort to reduce opioid prescribing and standardize postoperative pain management at an academic hospital. The investigators identified several barriers to improving prescribing, including time and resource constraints and fear of harming patient satisfaction.

This secondary analysis of a prior randomized trial of flexible versus mandated duty hours for trainee physicians examined reasons for staying past the end of a 24-hour call. Most trainees reported voluntarily staying longer, though a significant proportion reported that program, attending, or senior resident expectations to stay longer influenced them. Reports of coercion to remain were less common, and the authors urge programs to ensure that trainees are not being coerced to exceed duty hours.

… New Engl J Med … Duty hour reform for trainees was undertaken to …

This commentary describes a case involving a patient with obstructive sleep apnea who received multiple sedating medications and subsequently had a cardiac arrest while undergoing MRI. The authors explore root causes and provide suggestions for improving the safety of care for patients with obstructive sleep apnea.

This case report describes an insulin dosing error during hospitalization. The investigation uncovered several root causes, including lack of a standardized medication double-check. The authors note that prompt error disclosure to the patient and family was performed, and the patient required additional monitoring but experienced no further harm.

This commentary describes a case of wrong-site surgery, an erroneous breast biopsy, and the resulting disclosure of the error and investigation. Root cause analysis uncovered multiple process vulnerabilities. The authors suggest that errors provide opportunities to design system solutions to prevent errors.