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.
Hewitt DB, Ellis RJ, Chung JW, et al. Ann Surg. 2021;274:396-402.
This cross-sectional survey of general surgery residents to assessed resident wellness and self-reported error and compared these results against National Surgical Quality Improvement Program (NSQIP) registry data to assess patient outcomes. Over a six-month period, 22.5% of residents self-reported a near-miss medical error and nearly 7% reported an error resulting in patient harm. Residents reporting harmful medical errors were more likely to report symptoms of burnout and poor psychiatric well-being, but researchers did not find any significant association between well-being and adverse postoperative patient outcomes reported in the NSQIP registry.
Ban KA, Gibbons MM, Ko CY, et al. Anesth Analg. 2019;128:879-889.
Standardization of care protocols has been shown to improve perioperative outcomes. This article presents the results of an evidence review to develop best practices for perioperative care around colorectal surgery. The authors acknowledge the need for local tailoring in implementing these recommendations.
Liu JB, Berian JR, Ban KA, et al. Ann Surg. 2017;266:411-420.
The practice of scheduling concurrent surgeries has raised concerns about inadequate supervision of trainees. This National Surgical Quality Improvement Program study used propensity score matching to compare outcomes of concurrent versus nonoverlapping surgeries and did not find any difference in risk of death or serious morbidity, reoperation, or readmission. The authors state that while these results are reassuring, there is a need for further study to determine the safety of concurrent surgery.
Ban KA, Minei JP, Laronga C, et al. J Am Coll Surg. 2017;224:59-74.
Surgical site infections are a persistent and costly challenge to patient safety. These guidelines provide recommendations to reduce this common hospital-acquired condition, including policies for surgeon attire, hand hygiene, and equipment sterilization.
Bilimoria KY, Chung JW, Hedges L, et al. New Engl J Med. 2016;374:713-727.
Resident physician duty hour policies have generated rigorous debate, particularly following the most recent ACGME changes implemented in 2011, which shortened maximum shift lengths for interns and increased time off between shifts. This national study cluster-randomized 118 general surgery residency programs to adhere to current ACGME duty hour policies or to abide by more flexible rules that essentially followed the prior standard of a maximum 80-hour work week. Between these two groups, there were no significant differences in patient outcomes, including death and serious complications. Residents reported similar levels of satisfaction with their overall education quality and their well-being. An accompanying editorial notes that the study authors interpret these results as supporting flexible work-hour rules. Alternatively, the editorial author suggests that this study refutes concerns that the new policy compromises patient safety, and as such there is no compelling reason to backtrack on its implementation.
Rajaram R, Chung JW, Cohen ME, et al. J Am Coll Surg. 2015;221:748-57.
This pre-post examination of data from the National Surgical Quality Improvement Program found no differences in serious morbidity or mortality within 30 days following surgery across multiple surgical specialties in the 2 years after 2011 ACGME duty hour reform, compared to the last year prior to reform. Although duty hour reform does not appear to be a high-yield strategy for improving surgical outcomes, concerns about worsening procedural skills and increased handoffs leading to patient harm were not borne out in the current data.
Sacks GD, Shannon EM, Dawes AJ, et al. BMJ Qual Saf. 2015;24:458-67.
Previous literature has shown that safety culture and nontechnical skills (such as communication) can affect safety and clinical outcomes in patients undergoing surgery. This systematic review identified several interventions that demonstrated effectiveness at improving various aspects of surgical culture, including teamwork and communication. A past AHRQ WebM&M commentary discussed disruptive behavior as a contributor to safety issues in surgery.
Merkow RP, Ju MH, Chung JW, et al. JAMA. 2015;313:483-495.
Hospital readmissions have received intensive focus lately, largely compelled by Medicare's expanded financial penalties for excessive readmission rates. This study reviewed 30-day readmissions following surgery at hospitals enrolled in the National Surgical Quality Improvement Program. Nearly half a million operations were included, with an overall readmission rate of 5.7%. Following lower extremity vascular bypass, approximately 1 in 7 patients were readmitted. Surgical site infections accounted for the largest proportion of overall readmissions. It is notable that only 2% of patients were readmitted for the same complication that prompted their index admission, further confirming that surgical readmissions are overwhelmingly due to new complications arising from the procedure. In an accompanying editorial, Dr. Lucian Leape notes that analyses of these surgical complications can serve as "treasures" for providing important lessons for improvement, and he calls for a 50% reduction in surgical complication rates in the near term.
Rajaram R, Chung JW, Jones AT, et al. JAMA. 2014;312:2374-84.
This observational study analyzed surgical outcomes before and after 2011 ACGME duty hours reform using data from the American College of Surgeons National Surgical Quality Improvement Program. Researchers applied difference-in-differences analysis, which can account for some of the uncertainty of nonrandomized data, a common concern in patient safety research. They assessed changes in surgical mortality and complication rates before and after implementation of duty hours restrictions in teaching hospitals. The authors compared this difference with mortality and complication rates during the same time period in nonteaching hospitals. Any variation between teaching and nonteaching sites could be attributed to the effects of duty hours, since the authors accounted for case mix and comorbidities. No differences in patient outcomes were observed, adding to the evidence that duty hours restrictions do not improve patient outcomes. Researchers also found no change in trainee examination scores, despite concerns that duty hours adversely impact trainee education. An editorial discussing this work and a companion study urge flexibility in duty hours for physicians in training.
Paruch JL, Ko CY, Bilimoria KY. JAMA Surg. 2014;149:887-8.
This commentary reveals limits to using the AHRQ Patient Safety Indicator for accidental puncture and laceration as a safety measure. The authors recommend solutions, such as using surgeon-reported data to determine appropriate variables and narrowing variables to include only injuries that require significant intervention.
Operating room briefings or time-outs are mandated by The Joint Commission as a strategy to prevent wrong-site surgery. This commentary explores the use of briefings both before and after surgery, evidence regarding their impact, and how a comprehensive unit-based safety program (CUSP) initiative designed and implemented a briefing and debriefing process.