This simulation study presented virtual patient cases to practicing physicians with the aim of improving diagnostic accuracy. Physician participants reported challenges using the computerized platform, and overall diagnostic performance was poor, with less than a third of respondents identifying the correct diagnosis. This study highlights the challenge of developing interventions to enhance diagnostic performance.

This qualitative study examined incident reports about surgical patients, comparing trainee reports to those submitted by attending surgeons and nurses. Trainees were more likely to enter reports anonymously and completed more elements for each report, but they also used more blame language and submitted fewer reports overall. The results suggest that encouraging trainee reporting may shed light on surgical safety.

… to those working within standard duty hours. As in a prior study of surgical training, program directors of … effects of duty hour reform on graduate medical education. A PSNet perspective reviewed changes to the ACGME …

Analyzing data from a prior trial of flexible versus traditional duty hours, this study found that female residents perceived patient safety as worse than male residents. Changes in duty hours had mixed effects on these self-reported outcomes and seemed to exacerbate gender differences. The authors recommend further study to determine how to improve learning for trainees regardless of gender.

Hospitals rely on incident reporting systems to detect safety issues, but these systems are voluntary and do not capture all adverse events or near misses. Researchers developed and tested a prospective surveillance tool to identify teamwork errors in the pediatric intensive care unit. They found that this tool helped uncover safety issues not captured by the hospital's patient safety reporting system.

… Satisfaction with handoff procedures was suboptimal, and a significant proportion of respondents could recall an … that despite extensive work in this area, handoffs remain a persistent safety vulnerability. …

… the quality of teaching on resident rounds has become a challenge in light of new pressures to improve value, as … trainee accreditation standards. This commentary describes a rounding process that focuses on enhancing safety culture , …

This focus group study with emergency medical services personnel identified several potential ways to improve the quality of handoffs between paramedics and emergency department staff. A structured handoff tool has been developed to address this known safety hazard.

This commentary discusses how two medical centers utilized the fishbone diagram as a tool to analyze diagnostic errors. A health care facility in Maine developed a root cause analysis model to determine common factors, and a residency program in Pennsylvania introduced a modified fishbone diagram to educate trainees about cognitive biases and systems issues.

A longitudinal curriculum for internal medicine residents, using simulated patient scenarios, resulted in improved ability to recognize the cognitive biases that can contribute to diagnostic errors.

Engaging patients has been an area of emphasis for the safety movement, spurred by data demonstrating that patients often feel uncomfortable asking questions of their clinicians. This survey found that most parents of hospitalized children were interested in participating in hand hygiene efforts, but one-third would feel uncomfortable reminding health care workers to wash their hands. This reluctance has been documented in prior studies and may arise from patients' fear of endangering their relationship with the care team. In order to address these barriers, the Agency for Healthcare Research and Quality recently published a guide to patient and family engagement in quality and safety programs, which was designed with input from clinicians and patients.

In this study, communication between inpatient and outpatient dialysis units at discharge was highly variable.

… sleep time during such extended shifts. Conducted at a single internal medicine residency's two teaching hospitals, this randomized controlled trial …

In this national survey administered prior to the implementation of the 2011 Accreditation Council for Graduate Medical Education regulations, the majority of surgery residents did not feel that further duty hour restrictions would likely improve quality of care.

Internal medicine residents generally had positive views of the quality of their clinical supervision and the impact of duty hour regulations on patient care. This survey was completed before the implementation of further duty hour restrictions in 2010.

Diagnostic errors have been described as the next frontier in patient safety. Cognitive biases are common causes for these errors but have remained an elusive target for medical educators. This study describes an educational intervention for internal medicine residents consisting of reflective writing and facilitated small group discussions about personal experiences with diagnostic errors. Participating residents identified at least one cognitive bias and one contextual factor that may have contributed to their error. The most frequently implicated biases were anchoring and availability. Most residents also described a strategy to prevent similar errors in the future. A near miss stemming from an initial diagnostic error is highlighted in an AHRQ WebM&M commentary.

Conducted before implementation of the 2011 ACGME duty hour limits, this survey found that the majority of internal medicine and surgery program directors believed the new regulations would negatively affect the learning environment and continuity of care, as well as result in increased faculty workload and require changes in clinical services.