Supporting and improving clinician well-being has long been a safety focus and received renewed focus during the COVID-19 pandemic. This study sought to understand efforts undertaken to support clinicians’ well-being in Joint Commission-accredited hospitals and Federally Qualified Health Centers (FQHC). Only half of responding hospitals and FQHCs reported implementing at least one action towards improving clinician well-being (e.g., establishing a wellness committee) and few had implemented a comprehensive approach.

Problem lists, while an important part of high-quality care, are frequently incomplete or lack accuracy. This study examined the effectiveness of leveraging indication alerts in electronic health records (EHR) (medication ordered lacking a corresponding problem on the problem list) in two different hospitals using different EHRs. Both sites resulted in a proportion of new problems being added to the problem list for the medications triggered. Between 9.6% and 11.1% were abandoned (order started but not signed), which needs further study.

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … Testing process improvements prior to … for mistakes may have resulted in treatment delays. … Baker DW, Campbell R. Standardized Orders for Titrating …

Medication errors occur frequently in the outpatient setting and can lead to patient harm. A common scenario is one in which a patient is prescribed multiple medications, does not know what each one is for, and takes them incorrectly. Medication safety experts have advocated that prescribers include indications on prescription labels to enable patients and pharmacists to check the bottle in order to remember a medication's purpose. Investigators examined more than 4 million outpatient prescriptions from a single institution and found that only 7.4% of prescriptions included an indication. Medications for symptoms like pain, nausea, and anxiety were much more likely to have indications than medications for chronic diseases. Internal medicine physicians, whose patients are more likely to take multiple medications, wrote indications 6% of the time. A PSNet perspective explored how community pharmacists can use medication indications and other tools to ameliorate medication-related harm.

The Joint Commission identifies inpatient suicide as a sentinel event. Little is known about the epidemiology of hospital suicides other than that they are rare and occur mostly in psychiatry wards. Researchers examined two national databases to develop the first data-driven appraisal of hospital suicide rates. Nationally, between 49 and 65 hospital suicides occur each year. Nearly 75% happen during psychiatric treatment, and the most common means of death is hanging. This hospital suicide rate is an order of magnitude lower than prior estimates. An accompanying editorial raises concerns about the much larger epidemic of suicide immediately after psychiatric hospital discharge. A prior WebM&M commentary highlighted additional strategies to reduce hospital suicide risk.

Professionalism in medicine is considered an essential component of safety culture, but efforts to monitor and address disruptive behaviors among physicians have not produced the desired outcomes. This commentary discusses the need for more explicit emphasis on building physician skills and attitudes to support zero harm, process improvement, high reliability, and commitment to excellence in all areas of medical care.

This study found poor agreement between a traditional trigger tool and the use of automated queries of a data warehouse in identifying of adverse events.

Limited health literacy has been linked to poor comprehension of written instructions. This study found that spoken instructions were also frequently misunderstood by patients with poor health literacy.

Interdisciplinary teamwork is a primary driver of safety culture, and lack of teamwork has been linked to poor clinical outcomes in surgery and the emergency department. Creating high-functioning teams is challenging in inpatient medicine wards, due to numerous barriers including variability in physician and nurse schedules and communication styles. This study, which built on prior work by the same authors, sought to improve interdisciplinary teamwork at a teaching hospital by creating structured, daily rounds where the entire care team discussed patients. The intervention resulted in a significant decrease in preventable adverse events compared with historical and concurrent controls. The accompanying editorial notes that the hospital where this study was conducted had several structural features that also encouraged interdisciplinary communication (such as an electronic health record), and that structured interdisciplinary rounds could have an even larger impact at hospitals lacking such features.

… Journal of hospital medicine … J Hosp Med … Nights and weekends have been described as times …

This study describes the development and validation of the TeamSTEPPS Teamwork Attitudes Questionnaire, a survey instrument designed to measure attitudes toward teamwork in health care delivery. The TeamSTEPPS teamwork training program was developed as a collaboration between the Agency for Healthcare Research and Quality and the Department of Defense.

This AHRQ-funded study found that physicians usually chose appropriate reasons for excluding patients from inclusion in quality measurement programs.

Discrepancies in patients' medications at the time of hospital admission are common. Performed at an academic medical center, this cohort study used a pharmacist-led medication reconciliation process to determine a "gold standard" medication list for newly admitted patients, identify discrepancies between patients' medication lists and the medications ordered by admitting physicians, and investigate risk factors for preventable medication errors. More than one-third of patients had at least one discrepancy, with elderly patients and patients with more complex medication regimens being at higher risk—factors also documented in prior research. Patients who presented their own medication list or pill bottles were at reduced risk. The medication reconciliation process used in this study is available as an online toolkit.

The majority of hospitalized patients in this study could not name their hospital physicians and had significant misconceptions of their plan of care.

Introduction of an electronic discharge summary was associated with more timely communication with outpatient physicians and improved communication of potential patient safety problems, such as test results that were pending at the time of discharge.

This prospective cohort study found increased mortality among elderly persons with poor health literacy, even after adjusting for confounding factors. Poor health literacy has previously been linked to inability to understand prescription drug labels.

Patients discharged from the hospital experience an unacceptably high rate of medical errors. Prior research suggests that suboptimal communication between hospital physicians and outpatient physicians could contribute to these problems. This study systematically reviewed the literature to determine the frequency of communication problems between physicians at hospital discharge and to identify interventions that ameliorated this problem. The investigators found that direct communication occurred rarely, and the primary means of communication (the dictated discharge summary) generally was not available in a timely fashion and often contained inadequate information for proper follow-up care. Based on this review, the authors provide suggestions for standardizing information transfer at discharge and improving the timeliness of communication.

This article describes the development of the US Department of Defense's team training program for military health facilities, entitled TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). The program was based on two prior military crew resource management (CRM) programs and prior evidence in the field and was adapted to address issues encountered in military facilities, including the rapid turnover of personnel and the need to adapt to the cultures of specific military services. The program consists of teaching core skills in leadership, situation monitoring, team support, and communication through an interactive curriculum stressing application to everyday scenarios. The article extensively reviews the challenges of implementing the program and future plans for disseminating and evaluating the training.

This study addresses the relationship between low health literacy and comprehension of common prescription drug warning labels. Patients at an urban primary care clinic underwent structured interviews to address their understanding of specific one-step warnings (ie, take with food) and multi-step warnings (ie, avoid prolonged exposure to sunlight while taking this medication). The majority of the study population had low or marginal health literacy, defined as reading at an 8th grade level or lower. Patients with low literacy were significantly less likely to correctly interpret warning labels, and multi-step instructions were misinterpreted by the majority of respondents across all literacy levels. Misinterpretation of these common warnings could conceivably lead to misuse of medications or adverse drug events.