The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Khazen M, Sullivan EE, Arabadjis S, et al. BMJ Open. 2023;13:e071241.
Improving diagnostic quality is a patient safety priority. In this study, researchers used audio-recorded encounters, clinical note review, and interviews in order to evaluate a tool assessing key elements of diagnostic quality during clinical encounters. Many elements were reliably included in the clinical note or encounter transcript (e.g., follow-up contingencies, red flags) but other elements were often missing (e.g., psychosocial/contextual information). The researchers found that burnout was more common among physicians recording fewer key diagnostic elements.
Linzer M, Sullivan EE, Olson APJ, et al. Diagnosis (Berl). 2023;10:4-8.
Challenging working conditions and increased cognitive workload can result in stress and burnout. This article describes a conceptual framework in which working conditions and cognitive workload impact stress and burnout, which, in turn, impacts diagnostic accuracy. Potential uses and testing of the framework are described.
Watterson TL, Stone JA, Gilson A, et al. BMC Med Inform Decis Mak. 2022;22:50.
The CancelRx system is a health information technology-based intervention intended to mitigate the challenges of communicating medication discontinuation. Using secondary data from the electronic health record (EHR) system of a midwestern academic health system, researchers found that implementing the CancelRx system resulted in a significant increase in successful medication discontinuations for controlled substances.
Linzer M, Neprash HT, Brown RL, et al. Ann Fam Med. 2021;19:521-526.
Using data from the Healthy Work Place trial, this study explored characteristics associated with high clinician and patient trust. Findings suggest that trust is higher when clinicians perceived their organizational cultures as emphasizing quality, communication and information, cohesiveness, and value alignment between clinicians and leaders.
Watterson TL, Stone JA, Brown RL, et al. J Am Med Inform Assoc. 2021;28:1526-1533.
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.
Neprash HT, Sheridan B, Jena AB, et al. Health Aff (Millwood). 2021;40:1321-1327.
The COVID-19 pandemic led to an increase in the use of telehealth in order to limit patient exposure to the virus. Findings from this study highlight the value of telehealth visits for patients with suspected respiratory infections to prevent further transmission. Researchers found that patients exposed to influenza-like illness in primary care office settings were more likely than nonexposed patients to return with a similar illness within two weeks.
Olson APJ, Linzer M, Schiff GD. J Gen Intern Care. 2021;36:1404-1406.
… errors , particularly in the era of COVID-19 , persist. T he authors of this perspective proposed a new framework of … measures of diagnostic process safety. … Olson APJ, Linzer M, Schiff GD. J Gen Intern Med. Epub 2021 Feb 11. …
Menon NK, Shanafelt TD, Sinsky CA, et al. JAMA Netw Open. 2020;3:e2028780.
Burnout may adversely affect physician wellness and consequently patient safety. This cross-sectional study of 1,354 physicians found that depression was associated with suicidal ideation, while burnout was associated with self-reported medical errors.
Carayon P, Hoonakker P, Hundt AS, et al. BMJ Qual Saf. 2020;29:329-340.
This simulation study assessed whether integrating human factors engineering into a clinical decision support system can improve the diagnosis of pulmonary embolism (PE) in the ED. Authors found that this approach can improve the PE diagnostic process by saving time, reducing perceived workload and improving physician satisfaction with the technology.
The root causes of the opioid epidemic are complex, but inappropriate prescribing of opioids (which includes both prescribing opioids in situations where they are not indicated as well as excessive prescribing for appropriate indications) is a major contributor. Prior studies of outpatient antibiotic prescribing have shown that rates of inappropriate prescribing rise toward the end of clinicians' clinic sessions. This cross-sectional study used data from 5603 primary care physicians for acute painful conditions to analyze whether a similar relationship exists for opioid prescribing. Investigators found that the likelihood of opioid prescribing rose considerably as the workday progressed; clinicians were also more likely to prescribe opioids if their appointments were running late. In contrast, prescriptions for nonopioid therapies did not change in relation to appointment time. Although the magnitude of these effects was smaller than the variation in opioid prescribing rates between physicians found in other studies, these findings confirm that production pressure and decision fatigue contribute to inappropriate prescribing and should be addressed in quality improvement efforts to reduce opioid use.
Kroth PJ, Morioka-Douglas N, Veres S, et al. JAMA Netw Open. 2019;2:e199609.
This survey of 282 primary care physicians and ambulatory specialists found that several electronic health record design features contributed to clinician burnout, including excessive data entry requirements and long copied-and-pasted notes. However, other work environment factors (such as clinician workload) were more strongly predictive of work stress and burnout.
Cox E, Hansen K, Rajamanickam VP, et al. Hosp Pediatr. 2017;7:716-722.
Many institutions are encouraging patient and family engagement in safety initiatives. Prior research has shown that allowing parents to report safety concerns may help identify errors. In this study, investigators surveyed 170 parents at the time of their child's admission to the hospital to determine their desire to watch over the care provided. At discharge, parents were surveyed about medications and hand hygiene. They found that parents who wanted to watch over their child were more likely to question providers about medication use. The authors suggest that there may be additional opportunities for engaging such parents to improve safety. A past PSNet perspective discussed patient engagement and patient safety.
Linzer M, Sinsky CA, Poplau S, et al. Health Aff (Millwood). 2017;36:1808-1814.
Clinician burnout is a pressing patient safety issue. This pre–post study found that improving clinicians' work conditions (e.g., chaos, communication, values alignment, and cohesion) led to a subsequent reduction in burnout and increased likelihood of remaining in their medical practices. The findings suggest that clinicians' satisfaction can be improved by addressing workplace conditions.
Cox E, Jacobsohn GC, Rajamanickam VP, et al. Pediatrics. 2017;139.
Family-centered rounding is a key patient engagement strategy for hospitalized children. In this cluster-randomized trial that included nearly 300 families, 2 pediatric inpatient services implemented a checklist to promote family-centered rounding and 2 services provided usual care. Through observation of video-recordings, investigators determined that teams who were given a checklist were more likely to ask families if they had questions and to read back provider orders for confirmation. Although families' perceptions of safety climate improved with checklist implementation, overall quality and safety ratings between the checklist and usual care groups were similar. This trial provides evidence that performing certain elements of the checklist, such as read back, can modestly enhance patient and family engagement.
Dyrbye LN, Trockel M, Frank E, et al. Ann Intern Med. 2017;166:743-744.
Clinician burnout is increasingly recognized as a patient safety concern. This commentary summarizes the results of a consensus-building conference focused on physician burnout. The authors outline recommendations from the session to move the research base forward, including the need for collaboration to address the problem and examining the relationships between burnout, physician well-being, and care outcomes.
This human factors study examined how electronic health record (EHR) implementation affected medication safety. Researchers encountered improvements in transcription, dispensing, and administration errors after EHR introduction. Several types of medication prescribing errors, including choosing the wrong drug, duplicate orders, or orders with incorrect information, increased with EHR use. This study adds to the evidence suggesting EHR implementation has mixed effects on medication safety.
Carayon P, Du S, Brown RL, et al. J Healthc Risk Manag. 2017;36:6-15.
Despite the demonstrated success of technology in reducing medication errors, preventable adverse drug events remain a significant source of harm to patients. Researchers analyzed data on medication safety events in 2 ICUs at a medical center and found 1622 preventable adverse drug events among 624 patients. About one third of these events were related to electronic health record use, including duplicate orders.
Linzer M, Poplau S, Brown RL, et al. J Gen Intern Med. 2017;32:56-61.
Burnout among clinicians is a widespread patient safety concern. This study compared usual outpatient medical care to an intervention designed to improve clinician working conditions, with the aim of reducing medical errors and enhancing performance on a bundle of care quality measures. The intervention included an assessment of clinician perceptions of working conditions and well-being followed by a locally designed quality improvement project. Each clinic designed an intervention to address the concerns that arose from the assessment. Some clinics chose to work on improving communication or team-based chronic disease management while others focused on redesigning the clinic workflow. Investigators randomized 34 clinics either to receive the intervention or to continue their usual practice and found no differences in medical error rates or care quality measures between the clinics. The authors determined that reducing clinician burnout may not necessarily enhance patient safety and conclude that longer-term, standardized improvement interventions may be needed to augment health care quality.
This commentary describes misprognosis as enacting inappropriate intervention for a correct diagnosis. In light of the current emphasis on diagnostic error, the authors emphasize the need for clinicians to consider patient physical and social contexts when selecting interventions after diagnosis. They call for research to explore how education, measurement, and system can be improved to reduce prognostic errors.