The COVID-19 pandemic led to a rapid transition of healthcare from in-person to remote and virtual care. This review assessed the safety and effectiveness of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. Results show RPM was safe for patients in identifying risk of deterioration. However, it was not evident whether remote pulse oximetry was more effective than other virtual methods, such as virtual visits, monitoring consultations, or online or paper diaries.

… of self-referred emergency hospital admission. … Cecil E, Bottle A, Majeed A, et al. Factors associated with potentially missed …

Older adults, especially older adults with multimorbidities, are at increased risk of severe illness or death from COVID-19. General practitioners (GPs) in the UK were interviewed about how COVID-19 policies affected care of older adult patients with multimorbidities in their practices. Five major themes emerged: changes in primary care, involvement of GPs in policy making, communication and coordination, worries and stressors, and suggestions for improvement across the first four themes. COVID-19 policies have provided opportunities to continue providing safe healthcare for older adults with medical complexities, but they also highlight possible areas for improvement.

Social distancing precautions due to the COVID-19 pandemic have led to increased use of telehealth. The authors of this systematic review conclude that there is insufficient evidence to determine whether remote prescribing in primary care changes antibiotic prescribing practices. Future research should further assess remote prescribing to ensure there are no negative impacts on antimicrobial stewardship.  

Health care safety is a global concern. This review examined the literature on improvement experience from developed countries and identified common themes. The authors recommend a patient-centered, systems-oriented approach built on leadership, teamwork, transparency, and communication as key elements for effectively implementing improvement efforts in developing countries.

Measuring hospital quality remains challenging, despite numerous public efforts. Inpatient mortality represents one measure of hospital quality. Researchers sought to assess the association between alerts generated by the Imperial College Mortality Surveillance System (a national hospital mortality surveillance system that generates monthly mortality alerts) and trends in the relative risk of mortality across National Health Service hospital trusts. On average, mortality risk decreased after a trust received a mortality alert. However, the authors conclude that random variation could account for the alerts and that a causal relationship cannot be determined. A past PSNet perspective discussed the use of risk-adjusted mortality as part of a safety measurement program.

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.

… discussed diagnostic errors in more detail. … Tudor Car L, Papachristou N, Bull A, et al. Clinician-identified …

Nearly 2 decades into the patient safety movement, measurement of safety events remains a challenge. In particular, methods to measure safety that are patient-centered and can be compared across organizations are not standardized. This study proposes adverse event–free admissions as a potential measure of safety, defining the term as any hospitalization in which the patient does not experience a preventable adverse event. In analyzing nearly 24 million Medicare admissions, investigators found that only 64% were adverse event-free. When evaluating admissions for colorectal surgical procedures, the authors were able to identify a subset of hospitals with markedly higher rates of adverse events using this metric, implying that the measure may be suitable for interhospital comparisons. The recent National Patient Safety Foundation report, Free From Harm, identified safety measurement as a high priority for the field, and this study is a promising step forward. A previous PSNet perspective discussed challenges associated with safety measurement.

The weekend effect is a well-documented phenomenon across a range of health care outcomes. This study found worse outcomes following elective surgery done on Friday, Saturday, or Sunday compared with other days of the week, even after adjusting for patient, provider, and hospital factors. This work adds evidence to the depth and breadth of the weekend effect.

The weekend effect, in which adverse events occur more commonly outside of normal working hours, has been noted across multiple health care settings. In this retrospective observational study, investigators examined maternal and neonatal quality measures for deliveries occurring on Tuesdays compared with deliveries during the weekend. They found that four of seven performance measures studied were worse during the weekend, but staffing levels did not seem to explain the higher complication rate on weekends. This study is consistent with prior work suggesting patient safety vulnerabilities during the weekend, but further investigation of the weekend effect is required.

This study reviews insights from interviews of primary care physicians, practice nurses, practice managers, and members of clinical governing bodies and regional patient safety teams in London. The participants described many barriers to patient safety in primary care and offered specific recommendations for improving the use of data and patient safety monitoring.

The weekend effect of worse patient outcomes when admissions or procedures occurred outside of usual business hours has been documented across multiple care settings. In this analysis of pooled hospital administrative data across four countries, in-hospital mortality within 30 days of admission or surgical procedure was higher for patients admitted from the emergency department or undergoing interventions during the weekend, although there were specific differences by country. This consistency suggests that challenges with current weekend structure at hospitals should be examined across a broad range of clinical services and delivery models. An accompanying editorial suggests that the existence of the weekend effect is no longer in dispute and urges efforts toward identifying and addressing its underlying causes.

This systematic review explored many aspects surrounding patients' online access to electronic health records. Although patients seem to appreciate the access, health professionals have multiple concerns about privacy and increased workloads. No studies have reported any effects of patient online access on health outcomes.

This large National Health Service survey found a weak correlation between increased staff satisfaction and lower hospital standardized mortality.

Multiple prior studies have identified increased mortality, preventable complications, and delays in undergoing urgent procedures for patients admitted to the hospital on the weekend. This phenomenon has been termed the "weekend effect." With this large, retrospective cohort study, evidence of inferior weekend care now includes patients with acute stroke. The study, which involved nearly 100,000 stroke patients admitted to hospitals in the United Kingdom, found significantly lower performance across 5 of 6 quality and safety indicators for patients admitted on the weekend. Most notably, the rate of 7-day in-hospital mortality for Sunday admissions was 11.0%, compared with 8.9% for weekday admission. The authors note that 350 in-hospital deaths may be avoidable each year if care provided on weekends equaled that provided on weekdays.

This study found that unsolicited patient ratings of hospitals in the United Kingdom correlated reasonably well with standard measures of patient satisfaction with hospital care.

The AHRQ Patient Safety Indicators (PSIs) screen administrative data to identify cases of potential adverse events. This review analyzes studies of PSIs and other administrative data screening tools to identify how to refine the accuracy of these tools.

Despite large volumes of data generated in primary care settings, this literature review noted a paucity of data that is routinely used to measure adverse events.