Identifying and classifying adverse events is an important, yet often challenging, component of incident reporting. This article describes the development and testing of a novel Quality Improvement Classification System (QICS) designed to incorporate adverse events in both inpatient and outpatient settings across medical and surgical specialties in order to capture a broader range of outcomes related to patient care, including organizational issues, near-miss events, and expected deviations from ideal outcomes of surgery.

Emergency room crowding is a persistent factor that degrades safety for patients of all ages. This collection provides background, best practices, and recommendations to reduce emergency department crowding and its negative impact on pediatric care. The publications examine factors that influence crowding and improvement at the input, departmental, and hospital/outpatient stages of emergency care.

Children with emergent care needs are often cared for in complex situations that can diminish safety. This joint policy statement updates preceding recommendations to enhance the safety of care to children presenting at the emergency department. It expands on the application of topics within a high-reliability framework focusing on leadership, managerial factors, and organizational factors that support safety culture and workforce empowerment to support safe emergency care for children.

Racial bias in physicians and nurses is known to have a negative impact on health outcomes in patients of color; however, less is known about how racial bias in other healthcare workers may impact patients. This study used the Burgess Model framework for racial bias intervention to develop online modules related to racial disparities, implicit bias, communication, and personal biases to help healthcare workers to reduce their implicit biases. The modules were positively received, and implicit pro-white bias was reduced in this group. Organizations may use a similar program to reduce implicit bias in their workforce.

… for controlled substances. … Watterson TL, Stone JA, Gilson A, et al. Impact of CancelRx on …

Prior research has found that ambulatory electronic health records cannot communicate medication discontinuation instructions to pharmacies. In this study, the implementation of the CancelRx system led to a significant, sustained increase in successful medication discontinuations and reduced the time between medication discontinuation in the clinic EHR and pharmacy dispensing software.

Implicit bias can contribute to poor decision-making and lead to poor patient outcomes. This qualitative study found that many healthcare providers have negative implicit attitudes about American Indians, such as implicitly stereotyping American Indians as "noncompliant" patients. The effect of these implicit attitudes and stereotypes was moderated by self-reported cultural competency and implicit bias training.

Reducing resident shift duration can improve resident health and patient safety. This study found that resident shifts limited to 16 hours can reduce performance impairment and medical errors, compared to extended work shifts (24+hours).

… infection prevention and control. … Pogorzelska- Maziarz M, Chastain AM, Mangal S, et al. Home health staff …

… for healthcare organizations starting support programs. … Stone M. Second victim support programs for healthcare …

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.

This study describes the results of surveillance for COVID-19 among residents and staff of an independent/assisted living community in Seattle, Washington. Residents and staff were tested for COVID-19 and completed a symptom questionnaire assessing systems for the preceding 14 days; residents (but not staff) were retested 7 days later. COVID-19 was detected in 3.8% of residents and 3.2% of staff; none of the residents reported significant symptoms but the staff were symptomatic. After 7 days, resident testing was repeated and one new asymptomatic infection was detected. This study highlights the challenges of detecting COVID-19 in asymptomatic persons and the importance of early surveillance and prevention strategies in reducing virus transmission in assisted living communities.

Prior research has shown that nurse staffing is an important consideration with regard to patient safety. Lower nurse-to-patient ratios are associated with increased mortality and have prompted policies mandating particular nurse staffing ratios, especially in the intensive care unit. To address the criticism that previous studies have compared different institutions with higher nurse staffing to those with lower staffing levels and that there may be other reasons for observed differences in patient outcomes, this study evaluated the relationship between inpatient mortality and exposure to shifts with decreased registered nurse staffing, lower nursing support staffing, and increased patient turnover at three sites within a single academic medical center. Consistent with prior studies, researchers found an association between low nurse and nursing support staffing and increased patient mortality; there was no association between patient turnover and mortality. An accompanying editorial advocates for additional prospective research on interventions put in place to address nurse staffing.

Simulation is a valuable tool to identify latent safety threats when implementing changes to healthcare delivery. This article describes the development and implementation of a simulation-based clinical systems testing (SbCST) program to identify latent safety threats in healthcare systems prior to patient exposure.

Simulation is used to assess process and team performance and prevent failure. This commentary discusses the Promoting Excellence And Reflective Learning in Simulation (PEARLS) framework and how the modifiable debriefing strategies in the framework can help identify system-level problems and implement changes to enhance patient safety.

In this clustered-randomized trial across six academic medical centers, researchers examined the impact of resident shift duration on hours slept and worked per week during pediatric intensive care unit rotations. They found that residents assigned to extended duration shifts lasting 24 hours or longer worked more hours per week and slept fewer hours per week compared to residents assigned to work shifts lasting 16 hours or shorter.

… increase in hysterectomy complication rates. A WebM&M commentary discussed possible interventions to reduce …