Improving diagnosis remains a major focus within patient safety. For patients with rare diseases, diagnosis can often be delayed. Established in 2014 and funded by the National Institutes of Health, the Undiagnosed Diseases Network (UDN) applies a multidisciplinary approach to the most challenging diagnostic cases. Over a 20-month period, 601 out of 1519 patient cases were accepted by the UDN for evaluation. The authors report that of the 382 patients who underwent a complete evaluation, a diagnosis was identified in 132 patients.

Duty hour reform for trainees was undertaken to improve patient safety. However, experts have raised concerns that duty hour limits have reduced educational opportunities for trainees. This study randomized internal medicine residency programs to either standard duty hour rules from the Accreditation Council on Graduate Medical Education (ACGME) or less stringent policies that did not mandate the maximum shift length or time off between shifts. Investigators found that trainees in both groups spent similar amounts of time in direct patient care and educational activities, and scores on examinations did not differ. Interns in flexible duty hour programs reported worse well-being and educational satisfaction compared to those working within standard duty hours. As in a prior study of surgical training, program directors of flexible duty hour programs reported higher satisfaction with trainee education. These results may help allay concerns about detrimental effects of duty hour reform on graduate medical education. A PSNet perspective reviewed changes to the ACGME requirements to create flexibility for work hours within the maximum 80-hour workweek.

Residents working on a redesigned inpatient rotation with lower patient census completed higher quality discharge summaries compared with residents on a traditional rotation.

Reducing housestaff workload and increasing attending physician involvement resulted in higher educational satisfaction in this internal medicine residency program. However, quality measures and patient outcomes were essentially unchanged when compared with a traditional inpatient teaching service.

This study used a validated test instrument to assess residents and medical students and found deficits in their understanding of patient safety concepts.

This Agency for Healthcare Research and Quality (AHRQ)–supported study prospectively observed intensive care units over a 1-year period and analyzed captured incidents. Investigators used a variety of methods, including direct observation, to examine nearly 1500 patient-days. The incident rate per 1000 patient-days was greatest for the category defined as serious errors followed by that of preventable adverse events. Discussion provides details of the clinical patient characteristics, the range in severity of incidents, and specific examples and frequencies of the defined event types. The authors conclude that, while critical care settings offer vital services in treating patients, the setting also carries noted risks for adverse events and errors, and it is important to promote ongoing improvement efforts.

This AHRQ-supported study discovered that limiting intern work hours to less than 80 hours per week led to more sleep and less attentional failures while working nights in an intensive care unit. Investigators tracked sleep logs for twenty interns working in traditional (mean: 85 hours/week) and intervention (mean: 65 hours/week) schedules during three-week rotations. These logs were correlated with the presence of at least one electrooculophaphy-derived slow eye movement while at work, a validated marker for attention failures. The same investigator group reported the effect of reducing interns’ work hours on serious medical errors in an accompanying study.

With growing concern over the impact of intern sleep deprivation, this prospective study provides an error analysis comparing incidence rates during a traditional work schedule versus an intervention one. Investigators studied interns rotating though an academic intensive care setting and used a multidisciplinary approach to identify incidents, including direct observation. Results encompassed more than 2200 patient-days. The study found nearly 36% more serious medical errors and 5.6 times more serious diagnostic errors among interns working a traditional schedule (more than 24 hours in a row) than among interns working shorter shifts. The authors suggest that eliminating extended work shifts and reducing the hourly burden of an intern’s work week may reduce the incidence of serious medical errors.