COVID-19 ushered in new diagnostic challenges and changes in care practices. In this study conducted during the first wave of the pandemic, charts for hospitalized adult patients under investigation (PUI) for COVID-19 were reviewed for potential diagnostic error. Diagnostic errors were identified in 14% of cases; patients with and without diagnostic errors were statistically similar and errors were not associated with pandemic-related change practices.

Based on a survey of hospital medicine groups at academic medical centers in the United States (conducted April 2020), the authors of this study characterized inpatient adaptations to care for non-ICU COVID-19 patients. Sites reported rapid expansion of respiratory isolation units (RIUs – dedicated units for patients with known or suspected COVID-19), an emphasis on telemedicine for patient evaluation, and implementation of approaches to minimize room entry. In addition, nearly half of responding sites reported diagnostic errors involving COVID-19 (missing non-COVID-19 diagnoses among infected patients and missing COVID-19 diagnoses in patients admitted for other reasons).

This quality improvement evaluation found that a structured inpatient-to-outpatient handoff tool in the electronic health record was successfully implemented and improved the timeliness of communication, a key step in preventing postdischarge adverse events.

The introduction of a rapid response team—consisting of a critical care nurse and respiratory therapist—that proactively rounded on patients discharged from the intensive care unit did not improve clinical outcomes for those patients.

This study represents the first attempt to estimate the nationwide incidence of adverse drug events (ADEs) in ambulatory care. The investigators estimate that nearly 4.5 million ambulatory visits occur yearly due to ADEs, with older patients and patients who take more than 6 medications daily being at increased risk. The study did not assess preventability of ADEs, but prior studies have found that many patients suffer preventable ADEs in the outpatient setting; these were often linked to known high-risk medications. An AHRQ WebM&M commentary discusses an outpatient ADE related to a pharmacy dispensing error, and the Patient Safety in Ambulatory Care Primer discusses ADEs and other common outpatient safety issues.

This study describes prescribing patterns of potentially dangerous medications to nonpregnant young women, suggesting it occurs in 1 of every 13 clinic visits. The most frequent medications implicated include anxiolytics, anticonvulsants, and antibiotics such as doxycycline.

Focused efforts to enhance teamwork and communication have led to improved safety culture, though the impact on clinical outcomes is mixed. This multicenter study evaluated the impact of a series of teamwork and communication interventions over a 2-year period. The interventions included a teamwork training program, the development of unit-based safety teams, and patient engagement through daily goals and whiteboard use. Although a related study demonstrated that the interventions led to improved safety culture, this study found no impact on readmission rates or length of stay. Interviewing patients both during and after hospitalization, investigators found that patients perceived greater team function, but that they also perceived more safety gaps. This raises the possibility that patients' heightened awareness regarding patient safety and teamwork may lead them to identify more flaws in the system.