This multicenter cluster randomized trial explored the impact of eliminating extended-duration  work schedules (shifts in excess of 24 hours) on serious medical errors made by residents in the pediatric intensive care unit (ICU). The authors found that residents in ICUs which eliminated extended shifts in favor of day and night shifts of 16 hours or less made significantly more serious errors than residents assigned to extended-duration work schedules. The authors observed that the resident-to-patient ratio was higher during schedules which eliminated extended shifts, but also that these results might have been confounded by concurrent increases in workload in ICUs eliminating extended shifts.

This article presents longitudinal follow-up of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, which examined the effects of flexible duty-hour policies on resident outcomes. After four years, there was no evidence of increased duty-hour violations, decreased satisfaction or decreased well-being among residents randomized to flexible duty-hour policies. The researchers also observed that the beneficial impacts of flexible duty-hours persisted over the four-year period, whereas most of the negative effects diminished over time.

Poor test result management can lead to missed or delayed diagnosis. This qualitative study of clinicians involved in test result management found that lack of clear responsibility for test results, inability to track result follow-up via technology, and absence of standardized workflow and expectations impede timely test result notification and follow-up. The authors recommend employing both workflow and technology solutions to address this safety gap.

Medical imaging overuse is associated with increased rates of cancer related to radiation exposure. Researchers found that displaying radiation exposure and cost information to clinicians ordering radiologic studies may affect their decision to request diagnostic imaging and raise clinician awareness around radiation risks and study costs.

Patients' experiences with safety issues influence their perceptions of hospital quality. This study examined online reviews of hospitals and found concerns discussed in narratives that would not have surfaced using the Hospital Consumer Assessment of Healthcare Providers and Services patient satisfaction instrument. A significant proportion of narrative reviews raised concern about safety and trust.

Outpatient practices are increasingly using electronic referrals, or eConsults, to obtain clinical input from specialists because of insufficient access to subspecialty care. In an eConsult, the referring clinician (usually a primary care physician) will provide clinical information to the specialist via email or a web-based system. The specialist will review the information in the electronic medical record and decide whether further testing, treatment, or an in-person consultation is necessary. This retrospective study evaluated the safety of the electronic referral process by reviewing the medical records of patients who had been referred to a gastroenterology clinic and were not scheduled for in-person appointments. Investigators sought to determine the number of patients deemed not to require appointments and how many remained unscheduled. Emergency care or hospitalization for the referral complaint was rare overall; however, among patients whose electronic referrals remained unresolved (when investigators could find no decision regarding need for in-person visit and symptoms prompting referral were not addressed in the medical record), more than 70% were at moderate to high risk of potential harm. These cases included many patients who had no documented health care visits in the 6 months after the electronic referral was placed. Although the authors did not identify any definitive cases of harm attributable to failures of the electronic referral process, this study does highlight the need for robust tracking of eConsults to ensure appropriate follow-up by referring providers.

Opioid medications carry significant risk of adverse drug events. This observational study found that patients prescribed naloxone to treat overdose in home and community settings were less likely to have opioid-related emergency department visits compared to those not prescribed naloxone. This finding demonstrates the safety benefit of prescribing naloxone in outpatients.

… are explored further in an AHRQ WebM&M interview with Dr. Eric Coleman, a pioneer in the field of care transitions and …

Codeine is considered a high-risk medication in children due to variability in its metabolization. Despite recommendations against its use, this analysis of national data over a 10-year period found only a slight decrease in codeine prescriptions for children seen in the emergency department.

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.

The investigators found that professional interpreters positively affected communication and other elements of high-quality care for patients with limited English language skills.

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.