In this simulation study, emergency department physicians completed standardized tasks using actual electronic health records (EHRs) at four sites. Even though two sites used Epic and two used Cerner EHRs, the number of clicks per task, time to task completion, and error rates varied widely. The authors highlight the importance of local implementation decisions as well as design and development in supporting usability and safety of electronic health records.

Fatigue among health care workers represents a significant patient safety concern. This study describes the development of guidelines to reduce fatigue and its associated risks among emergency medical services personnel.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … Poor usability of electronic health …

Root cause analysis (RCA) is a process frequently employed by health care institutions to understand the sequence of events leading to an adverse event or near miss. Experts have previously highlighted flaws with the RCA process and suggested ways to improve it. In this study, researchers reviewed 302 RCAs and concluded that many of the proposed solutions were weak, consisting largely of educational interventions, changes to processes, and enforcing policy. A recent Annual Perspective explores ongoing problems with the RCA process and sheds light on opportunities to improve its application in health care.

The impact of fatigue on clinician performance is a concern across health care settings. This study explained how researchers developed key questions to help assess fatigue in prehospital emergency medical services. They describe a plan to conduct systematic reviews to inform future guidelines.

Severe sepsis has been a focus of quality efforts. This retrospective study contrasted community-acquired sepsis with health care–associated sepsis. In line with definitions of health care–associated infections, investigators defined health care–associated severe sepsis as patients hospitalized with severe sepsis with an infection present at admission, where the patient was admitted from an inpatient nursing facility, was on hemodialysis, or was readmitted within 30 days to the same hospital. They separately considered hospital-acquired sepsis cases in which the patients did not have an infection at hospital admission. Both health care–associated and hospital-acquired sepsis, which together accounted for about one-third of cases, had a higher mortality rate and were more severe and costly than community-acquired severe sepsis. This adds to the evidence that health care–associated infections cause significant harm and costs to patients. In a related study, researchers examined readmissions following severe sepsis and found substantial variation in readmission rates, with an overall rate of about 20%, suggesting that targeting sepsis in readmission prevention efforts may be helpful.

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … Resilience is a characteristic that …

… of the American Society for Healthcare Risk Management … J Healthc Risk Manag … The authors reviewed 334 root cause …

This commentary highlights elements of human factors that can be applied to improve efficiency and safety in health care.

This survey of emergency medical services (EMS) personnel found that lower perceived safety culture was associated with an increased risk of adverse events in patients and an increased risk of injury in EMS providers.

This study established a consensus definition and rating system for adverse events in emergency medical services (EMS). The guiding principles included a focus on events that were potentially preventable during the continuum of EMS care, and independent of a patient’s clinical progression.

This survey found that the perception of safety culture varied widely among prehospital emergency medical service agencies, with air medical emergency services tending to report slightly more positive views on safety.

This qualitative study found that while safety issues in pediatric prehospital care are not uncommon, most go unreported.

… the International Society for Quality in Health Care … Int J Qual Health Care … In this survey conducted in 30 intensive …

In this survey of emergency medical services providers, nearly half reported symptoms of severe mental and physical fatigue.

… journal of the American College of Medical Quality … Am J Med Qual … This article reports on the development and …

Out-of-hospital intubation errors were not associated with mortality but were associated with an increased rate of pneumonia.

This article describes how applying a just culture and systems approach to adverse events may help change the "blame-and-shame" mentality in emergency medical service provision.