Home health providers often detect medication discrepancies in patients recently discharged from the hospital. This study found that the presence of medication discrepancies was associated with an increased risk of hospital readmission.

Organizational infrastructure is important to ensure sustainability of safety improvements. This commentary describes how one academic medical center integrated structures, processes, and frameworks to build connections within the organization and throughout the community to facilitate success of improvement initiatives.

Resident physician duty hour regulations have primarily been driven by an impetus to improve patient safety, but evidence supporting this effect is largely lacking. This observational study compared patient outcomes between a resident medicine service and hospitalist (nonresident) medicine service at a large academic medical center, before and after the 2011 ACGME work hour reforms. Overall there were no significant differences in length of stay, 30-day readmission, inpatient mortality, hospital-acquired conditions, or intensive care unit admissions. A New England Journal of Medicine roundtable discussion explored the past decade of duty hour reforms, and a recent commentary by Drs. Halpern and Detsky called for more research evaluating the intended and unintended effects of these mandates. An AHRQ WebM&M perspective reviewed evidence surrounding the impact of resident duty hour limits on safety in health care.

Signs of burnout and fatigue were most often associated with being on a rotation that included shifts longer than 24 hours, in this survey of intern physicians at three internal medicine residency programs. The survey was performed immediately prior to implementing the 2011 duty hour restrictions, limiting intern shifts to 16 hours.

Central line–associated bloodstream infections (CLABSI) can be nearly eliminated through implementation of a safety bundle. Prior studies have argued that these interventions are cost effective because the money saved by preventing infections is greater than the cost of the program itself. This study substantiates these significant savings in hospital costs by avoiding CLABSI, but it finds a concomitant marked decrease in hospital reimbursement rates. Under the fee-for-service system, hospitals net a margin of approximately $55,000 for patients that develop CLABSI versus $6,500 in those that do not. Therefore, the business case for this quality improvement measure is purely for the payers, and the decrease in hospital margins for line infections sets up a "perverse incentive" for medical centers. This study adds to recent similar findings that surgical complications also often result in net profits for medical centers.

This commentary discusses barriers to understanding and measuring progress in safety improvement and describes seven priorities to guide development of patient safety measures.

The Accreditation Council for Graduate Medical Education (ACGME) has progressively restricted resident physicians' duty hours since 2003, with the goal of improving patient safety and resident quality of life. Despite evidence that the 2003 regulations had no significant impact on patient outcomes and may have adversely affected resident education, further regulations implemented in 2011 placed new restrictions on the duty hours of first-year trainees. This randomized controlled trial, in which two 2011-compliant internal medicine resident schedules were compared with the existing schedule (which was compliant with the 2003 regulations), represents one of the first assessments of the new regulations. The investigators found that although residents slept more under the new schedules, the number of handoffs increased dramatically, residents' attendance at teaching conferences decreased, and both residents and nurses perceived that the quality of patient care worsened. An accompanying editorial calls for the ACGME to eliminate shift length restrictions and instead focus on reducing overall resident workload.

A medication reconciliation process conducted by bedside nurses successfully identified unintended medication discrepancies at both admission and discharge; the practice also appeared to be cost-effective.

This study provides a comparative description of two interventions to improve care transitions following hospital discharge. Home nurse visits uncovered 62% more medication discrepancies than those detected by telephone interview.

… of committing a medical error. … Edrees HH, Paine LA, Feroli ER, Wu AW. Health care workers as second victims of …

… in adopting safe use of electronic health records. … Poe SS. Building nursing intellectual capital for safe use of …

Internal medicine faculty at US medical schools felt that duty hours regulations had negatively affected the quality of education for medical students. A prior companion study found similar perceptions of the regulations' effect on residency training.

… interdisciplinary planning and redesign of their hospital's medication administration system. … Dang D, Robert Feroli E, Gill C, et al. Quest for the ideal: a redesign of …

… Qual … The author describes one academic medical center’s program to infuse patient safety into the everyday work of … through new staff orientation and continuing education. … Poe SS. Patient safety: planting the seed.  J Nurs Care Qual …