In 2013, the UK National Health Service (NHS) implemented 7-day services to ensure that patients admitted on weekends receive quality care. To examine the impact of the policy, this analysis compared error rates among patients admitted to the hospital as emergencies on weekends versus weekdays before and after policy implementation. Error rates were not significantly different on weekends compared to weekdays, but errors rates overall improved significantly after implementation of 7-day services.

Patients admitted to the hospital on the weekend have been shown to experience worse outcomes compared to those admitted on weekdays. This weekend effect has been observed numerous times across multiple health care settings. However, whether patient characteristics (patients admitted on the weekend may be more severely ill) or system factors (less staffing and certain services may not be available on the weekend) are primarily responsible remains debated. In this systematic review and meta-analysis including 68 studies, researchers found a pooled odds ratio for weekend mortality of 1.16. Moreover, the weekend effect in these studies was more pronounced for elective rather than unplanned admissions. They conclude that the evidence suggesting that the weekend effect reflects worse quality of care is of low quality. A past PSNet perspective discussed the significance of the weekend effect with regard to cardiology.

This commentary discusses current challenges to safety in critical care, such as underperforming decision support, poor organizational learning, and clinician burnout. The authors envision safety improvements due to innovations in processes like wearable monitoring technology that enables rapid response activation, workflow-embedded reflective learning, and patient–clinician collaboration.

This commentary explores the results of a multidisciplinary discussion on the intersection of "respect" and "dignity" as requirements of safe care. The authors provide recommendations to encourage a strong system-level commitment to respect and dignity, which include the need to expand the research on respect in the intensive care unit and the value of responding to failures of respect as safety incidents to design mechanisms for improvement.

In-hospital mortality for many conditions is higher on the weekends than on weekdays—a phenomenon known as the weekend effect. Some hypothesize lower specialty physician staffing levels on weekends explains the mortality difference. This cross-sectional study compared specialist staffing levels and mortality rates at 115 hospitals in the English National Health Service on Sundays compared to Wednesdays. Researchers found a higher mortality rate and lower intensity of specialty services on weekends, but there was no correlation between the two ratios. Although this study is not definitive, it does imply that alternate mechanisms may explain the weekend effect, such as case mix differences, variation in nonphysician staffing, or lower availability of diagnostic services. A previous PSNet interview discussed the weekend effect in health care.

Achieving a positive safety culture requires that all team members feel comfortable voicing safety concerns. Hierarchy and poor communication are well-recognized barriers that prevent team members from speaking up about safety concerns. In this qualitative study across 19 intensive care units, researchers used data from hundreds of hours of ethnographic observation and interviews to understand how team members raised safety concerns and to characterize processes of social control exercised in response to mistakes, perceived safety risks, and deviations from normal practice. The authors argue that a better understanding of social control is necessary to facilitate voicing safety concerns in the clinical setting. A past WebM&M commentary discussed an incident involving a medical student who did not speak up when a urinary catheter was inserted without sterile technique.

The Matching Michigan program attempted to replicate the success of the Keystone ICU study at preventing central line–associated bloodstream infections in intensive care units (ICUs) in England. However, Matching Michigan was unsuccessful in that infection rates declined at similar rates in both intervention and control units. A counterpart to the landmark study exploring why the Keystone ICU study succeeded, this ethnographic analysis identified external factors (Matching Michigan was perceived as a regulatory, top-down initiative) and internal factors (participating hospitals had widely varying prior experiences with quality improvement projects) that influenced uptake and success of the project at the individual hospital level. Overall, only 1 of the 19 intervention ICUs studied truly transformed their practices and culture toward preventing hospital-acquired infections.

The Keystone ICU study, which nearly eliminated catheter-related bloodstream infections in intensive care units (ICUs) in Michigan, is a landmark achievement in the patient safety field. This controlled study, which attempted to replicate the Keystone study in 223 ICUs in England, yielded a surprising result: infection rates declined significantly in both control and intervention hospitals, likely reflecting secular trends in infection rates. The authors note the need for ethnographic studies to complement traditional clinical research in order to determine the reasons behind the success (or failure) of quality improvement efforts.

This article connects research in patient safety with the experiences of acutely ill patients in the hospital system. The authors stress teamwork and the standardization and improvement of care process reliability.

This article defines the key components of a "rapid response system" (RRS), which the authors propose as a unifying term for medical emergency teams, rapid response teams, and other similar teams designed to intervene on clinically unstable inpatients. An RRS should consist of an "afferent limb," the mechanism by which team responses are triggered; an "efferent limb," the team of clinicians that responds to an event; an administrative arm responsible for team staffing, education, and implementation; and a quality improvement arm to assess effectiveness of the RRS and identify underlying quality of care issues. RRS effectiveness should be monitored by measuring mortality, cardiac arrests, and unplanned intensive care unit admissions. The authors did not endorse a specific model for the efferent limb, stating that physician-led or nurse-led models may both be appropriate depending on local circumstances. No consensus was reached on whether all hospitals should be mandated to institute an RRS.