Patient and family engagement is essential to effective and safe diagnosis. OurDX is a previsit online engagement tool to help identify opportunities to improve diagnostic safety in patients and families living with chronic conditions. In this study, researchers implemented OurDX in specialty and primary care clinics at two academic healthcare organizations and examined the potential safety issues and whether patient/family contributions were integrated into the post-visit notes. Qualitative analysis of 450 OurDX reports found that participants contributed important information about the diagnostic process. Participants with diagnostic concerns were more likely to raise concerns about the diagnostic process (e.g., access barriers, problems with tests/referrals, communication breakdowns), which may represent diagnostic blind spots.

Patients and families are encouraged to play an active role in patient safety by, for example, reporting inaccurate or incomplete electronic health record notes after visits. In this study, patients and families at two US healthcare sites (pediatric subspecialty and adult primary care) were invited to complete a survey (OurDX) before their visit to identify their visit priority, recent medical history/symptoms, and potential diagnostic concerns. In total, 7.5% of patients and families reported a potential diagnostic concern, mainly not feeling heard by their provider.

… of AI that affect reliability. … Classen DC, Longhurst C, Thomas EJ. Bending the patient safety curve: how much can AI …

Patients who access their electronic health record (EHR) through a patient portal have identified clinically relevant errors such as allergies, medications, or diagnostic errors. This study focused on patient-identified diagnostic safety blind spots in ambulatory care clinical notes. The largest category of blind spots was diagnostic misalignment. Many patients indicated they reported the errors to the clinicians, suggesting shared notes may increase patient and family engagement in safety.

Striving for “zero harm” in healthcare has been advocated as a patient safety goal. In this article, the authors discuss the unintended consequences of “zero harm” goals and provide an alternative approach emphasizing learning and resilience goals (leveled-target goal setting, equal emphasis goals, data-driven learning, and developmental) rather than performance goals.

Opioid overdose and misuse continues to be a major public health concern with numerous policy- and organization-level approaches to encourage appropriate clinician prescribing. A northern California health system studied the effects of three interventions (individual audit feedback, peer comparison, both combined) as compared to usual care at several emergency department and urgent care sites. Peer comparison and the combined interventions resulted in a significant decrease in pills per prescription.

… J Healthc Qual … Medical errors in the neonatal intensive … including healthcare-acquired infection. … Nether KG,  Thomas EJ, Khan A, et al. Implementing a robust process … in the neonatal intensive care unit to reduce harm. J Healthc Qual. 2022;44(1):23-30. …

… J Perinatol … Patients in the neonatal intensive care unit … first seven days of admission was 6.2%. … Shafer GJ, Singh H, Thomas EJ, et al. Frequency of diagnostic errors in the …

… more long-term emotional, physical, and financial harm . … Bell SK,  Dong J, Ngo L, et al. Diagnostic error experiences of patients and …

… take contextual factors into consideration. … Ranji SR, Thomas EJ. Research to improve diagnosis: time to study the …

… J Patient Saf … This qualitative study explored the long-term … by patients and families after harmful healthcare events. J Patient Saf. 2021;17(8):e1145-e1151. …

Effective communication between patients and providers – including after an adverse event – is essential for patient safety. This qualitative study identified unique challenges experienced by parents and providers when communicating about adverse birth outcomes – high expectations, powerful emotions, rapid change and progression, family involvement, multiple patients and providers involved, and litigious environment. The authors outline strategies recommended by parents and providers to address these challenges.

Engaging patients and families in their own care can improve outcomes, safety, and satisfaction. This study brought patients, families, clinicians and experts together to identify patient-reported diagnostic process-related breakdowns. The group identified 7 categories, 40 subcategories, 19 contributing factors and 11 patient-reported impacts. Breakdowns were identified in each step of the diagnostic process.

… and drivers of safety culture. … Bisbey TM, Kilcullen MP, Thomas EJ, et al. Safety culture: an integration of existing …

Providing patients access to their medical records can improve patient engagement and error identification. A survey of patients and families found that about half of adult patients and pediatric families who perceived a serious mistake in their ambulatory care notes reported it, but identified several barriers to reporting (e.g. no clear reporting mechanism, lack of perceived support).  

… unprofessional behavior. … Kesselheim JC, Shelburne JT, Bell SK, et al. Pediatric trainees' speaking up about … threats. Acad Pediatr. Epub 2020 Jul 17. doi: 10.1016/j.acap.2020.07.014 …

This editorial discusses priority areas for maintaining and promoting the well-being of the healthcare workforce during the COVID-19 pandemic. The authors discuss the importance of providing adequate personal protective equipment (PPE), supporting basic daily needs (e.g., provision of in-hospital food stores), ensuring frequent and visible communication, supporting mental and emotional well-being, addressing ethical concerns, promoting wellness, and showing gratitude for staff.

This study surveyed over 22,800 patients across three health care organizations to assess how often patients who read open ambulatory visit notes perceive mistakes in the notes. The analysis found that 4,830 patients (21%) perceived a mistake in one or more notes in the past 12 months and that 42% of those patients considered the mistake to be somewhat or very serious. The most common very serious mistakes involved incorrect diagnoses; medical history; allergy or medication; or tests, procedures, or results. Older and sicker patients were more likely to report a serious error compared to younger and healthier patients. Using open notes and encouraging patient engagement can improve record accuracy and prevent medical errors

This article summarizes evidence-based recommendations for team-based patient care during the COVID-19 pandemic. These recommendations focus on team functioning, safety culture, and resilience. The authors discuss how individual-, team-, and organizational-level stressors, as well as work-life stressors, can affect team performance. 

Providing patients – particularly elderly, less educated, non-white, and non-English speaking patients – with access to their medical records via ‘open notes’ can improve engagement in care; however, these demographic groups are also less likely to take advantage of these e-tools. The authors summarize the preliminary evidence and propose steps to increasing use of open note portals among disadvantaged patients.