Patient safety is a global health concern. For this study, representatives from 27 countries reported on rules, laws, and policies in their country related to adverse events and medical errors. As expected, laws varied widely between countries regarding issues such as apology laws, patient compensation schemes, and legal and emotional support for clinicians involved in adverse events.

An accurate understanding of the frequency, severity, and preventability of adverse events is required to effectively improve patient safety. This study included review of more than 2,800 inpatient records from 11 American hospitals with nearly one quarter having at least one preventable or not preventable adverse event. Overall, approximately 7% of all admissions included at least one preventable event and 1% had a severity level of serious or higher. An accompanying editorial by Dr. Donald Berwick sees the results of this study as a needed stimulus for leadership to prioritize patient safety anew.

Adverse events in obstetrics threaten the safety of both maternal and infant patients. This study identified a significant reduction in malpractice claims among obstetrician-gynecologists after participation in simulation training focused on team training and crisis management.

This article describes an innovative expert consensus process to generate a contemporary list of chart-review based triggers and adverse event measures for assessing the incidence of inpatient and outpatient adverse events. A panel of 71 experts from nine institutions identified 218 triggers and measures with high or very high clinical importance deemed suitable for chart review and 198 were found suitable for electronic surveillance; 192 items were suitable for both.   

As part of a quality improvement initiative to enhance surgical onboarding, the authors used semi-structured interviews with 20 physicians to understand potential areas of risk when a physician begins working in an unfamiliar setting. Qualitative analysis found that three key findings: (1) physicians often receive little to no onboarding when starting to practice in a new setting, which can limit their ability to provide safe care; (2) physicians felt onboarding inadequately fostered strong interpersonal relationships among health care teams, which impedes psychological safety and team cohesion, and; (3) physicians noted an increased risk of patient harm during emergency situations in new settings due to lack of understanding of culture, workflow, roles/responsibilities and available equipment.

This study used a mixed-methods approach to characterize the impact of two academic fellowships in Quality Improvement Patient Safety (QIPS) to both graduates and their respective institutions. Students in these programs reported a positive impact of the fellowship on their careers, with nearly all being involved in QIPS administration, research or education upon graduation. Interviewed mentors also generally thought the fellowships were important and the resulting research had departmental, institutional and even national importance.

Physicians who receive more patient complaints about communication and behavior are more likely to face malpractice claims. This study examined whether results from surgeons' 360-degree reviews, in which team members evaluate a range of professional attributes and behaviors, were associated with risk of malpractice claims. Surgeons with worse performance for attentiveness, informing others, and considering others' suggestions had a significantly higher risk for malpractice claims. Surgeons in the highest 10% for the negative behaviors of snapping at or talking down to others also were more likely to have malpractice claims. These results echo prior studies of physician behavior and malpractice risk. The authors suggest that addressing negative behaviors among surgeons could mitigate malpractice risk. A previous WebM&M commentary discussed patient complaints as safety surveillance.

The effect of disclosure of errors on medical malpractice risk remains unclear. This retrospective observational study found that the rates of disclosure did not increase between 2011 and 2013, and volume of malpractice claims also remained unchanged. These results demonstrate that physicians infrequently disclose or apologize for errors, despite efforts to encourage disclosure of adverse events.

Patient safety has been described as an unmet need in physician training. This commentary describes the development and implementation of a patient safety curriculum in a pediatric primary care practice and the results of the program.

The communication of critical test results is a National Patient Safety Goal. This study describes an automated alert notification system for critical imaging results at a large academic medical center. The introduction of the system led to better closed-loop communication and appropriate documentation.

This commentary describes the development of a quality and safety clinical fellowship curriculum which focused on identifying core competencies and then incorporating training for these principles in an operational setting. A companion article explores the implementation of this curriculum at hospitals affiliated with Harvard Medical School.

This provocative study compared safety data from five separate sources to derive a comprehensive picture of institutional safety. The investigators compared safety issues identified through traditional event reporting, patient complaints, executive walk rounds, malpractice claims, and risk management databases, and found that while each method identified important safety problems, there was little overlap in the types of events identified with each reporting mechanism. For example, diagnostic errors were frequently cited in malpractice cases, but executive walk rounds highlighted equipment and supply issues. Prior research confirms the need to use multiple data sources to realistically analyze safety at the institutional level. An accompanying commentary discusses the strengths and limitations of a broad range of safety monitoring methods, including those used in this study.

This study discovered that physicians using electronic health records (EHRs) appear less likely to have paid malpractice claims, though as the authors point out, finding the nature and significance of this relationship requires further investigation.

The authors found preventable errors in more than half of the neurologic malpractice claims studied. They identified several contributors, including lapses in communication and problems with follow-up, diagnostic accuracy, and imaging.