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.

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.

… of reduced stigmatization. … Blease C, Kharko A, Hägglund M, et al. The benefits and harms of open notes in mental …

… step of the diagnostic process. … Bell SK, Bourgeois F, DesRoches CM, et al. Filling a gap in safety metrics: …

Adverse drug events (ADE) can occur in any healthcare setting. Using retrospective record review from three mental health hospitals, clinical pharmacists confirmed that ADEs were common, and that nearly one-fifth of those were considered preventable.

… is still a barrier . … Blease C, Salmi L, Hagglund M, et al. COVID-19 and open notes: a new method to enhance …

This study evaluated the impact of an electronic decision support tool comprising a comprehensive drug review to support deprescribing and reduce polypharmacy in elderly adults. Results indicate that the tool did reduce the number of prescribed drugs but did not significantly reduce unplanned hospital admissions or death after 24 months.

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

… also influenced safety culture and quality. … Jacobs S, Hann M, Bradley F, et al. Organisational factors associated with …

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.

… of omission errors in psychiatric hospitals. … Keers RN, Hann M, Alshehri GH, et al. Prevalence, nature and predictors of …

This paper describes the implementation of a "second victim" peer-support program in the surgery department at a tertiary care center. The program trained surgical attendings and trainees to provide peer-support for other surgeons involved in major adverse events. After one-year follow-up, 81% of affected surgeons elected to receive peer support. The majority (81%) felt the program had a positive impact on safety culture by providing a confidential, safe, and timely intervention for so-called "second victims". A 2011 Perspective on Safety with Dr. Albert Wu discussed ways that organizations can support "second victims."

OpenNotes provides patients with access to their health care provider’s documentation. This study found that patient access to such documentation may have the potential to improve medication adherence. A past PSNet interview discussed the OpenNotes project.

Past studies have explored the impact of nurse and clinician workload on the quality of care. In this study, researchers examined how general practitioners and administrative staff across eight United Kingdom practices work together to fill prescription requests and manage test results.

… and quality. … Blanchfield BB, Demehin AA, Cummings CT, Ferris TG, Meyer GS. The Cost of Quality: An Academic Health …

Medication use is a critical aspect of patient safety in outpatient settings. This direct observation and interview study examined how eight practices in the United Kingdom responded to patient requests for either new medications or medication refills outside of physician visits. Researchers looked at how the practices chose to trade off between speed of response (using nonphysicians to address requests) and thoroughness (having physicians review and approve requests). The interview participants noted hazards related to lack of physician review, such as prescribing an unsafe medication, and risks associated with delayed receipt of needed medications due to inefficiency. Practices with a larger number of requests and high physician workload, who cared for older and socioeconomically disadvantaged populations, were more likely to emphasize efficiency over thoroughness. Such emphasis may introduce additional prescribing safety concerns in a population already at significant risk for adverse drug events.

Ambulatory patients with chronic illness are at particular risk for safety concerns. In this survey study, about 10% of patients aged 65 and older with a chronic condition reported experience with a safety concern, including insufficient availability of test result information, unnecessary testing, or receiving the wrong type or dose of medication.

Test result management is a critical aspect of ambulatory patient safety. This direct observation study identified highly variable strategies across outpatient practices with different vulnerabilities. These results underscore the need to develop interventions to enhance management of test results.

Adverse drug events among outpatients are common and can lead to preventable complications. Conducted in primary care practices, this cluster-randomized trial found that a combination of professional education, electronic health record alerts, and financial incentives for practices to review potentially inappropriate prescribing decreased high-risk medication prescriptions. Investigators also observed a decrease in two of the three medication-related complications associated with use of high-risk medications, suggesting a clinical benefit to this intervention. The success of this study argues for similar larger-scale, multi-modal patient safety studies to detect modest but significant improvements.