… J Gen Intern Med … COVID-19 ushered in new diagnostic … not associated with pandemic-related change practices. … Auerbach AD, Astik GJ, O'Leary KJ, et al. Prevalence and causes of diagnostic errors …

Implementing successful interventions to support effective medication reconciliation is an ongoing challenge. The MARQUIS2 study examined whether system- and patient-level interventions plus physician mentors can improve medication reconciliation and reduce medication discrepancies. This analysis based on patient exposure in the MARQUIS2 study found that patient receipt of a best possible medication history (BPMH) in the emergency department and medication reconciliation at admission and discharge were associated with the largest reductions in medication discrepancy rates.

Team collaboration is an essential part of ensuring patient safety in acute care settings. This survey of care team members (including nurses, physicians, pharmacists, respiratory therapists, and rehabilitation therapists) assessed teamwork and collaboration across 68 intensive care units (ICUs). Teamwork and work environment were rated favorably but care coordination and meaningful recognition were rated least favorably.

… J Am Geriatr Soc … Medication reconciliations , including … among hospitalized older adults with polypharmacy. J Am Geriatr Soc. Epub 2021 Dec 31. doi: 10.1111/jgs.17629 …

Performance feedback is an essential component of patient safety and quality improvement. In this participatory study, researchers engaged hospitalists in design sessions and surveys to develop a performance dashboard and feedback system. Physicians preferred that the dashboard be used to aid in clinical practice improvement as part of a non-punitive system.

Implementing effective interventions supporting medication reconciliation is an ongoing challenge. Using qualitative data, the authors explored how different hospitals implemented one evidence-based medication reconciliation toolkit. Thematic analyses suggest that the most commonly used implementation strategies included restructuring (e.g., altered staffing, equipment, data systems); quality management tools (e.g., audit and feedback, advisory boards); thorough planning and preparing for implementation; and education and training with stakeholders.

… in unintentional mediation discrepancies over time. … Schnipper JL, Reyes Nieva H, Mallouk M, et al. Effects of a …

… Jt Comm J Qual Patient Saf … Teamwork is essential to providing high … in perceived teamwork across professional categories . … O'Leary  KJ, Manojlovich M, Johnson JK, et al. A multisite … and collaboration on general medical services.  Jt Comm J Qual Patient Saf. 2020;46(12):667-672. …

… J Hosp Med … Based on a survey of hospital medicine groups at … in patients admitted for other reasons). … Auerbach A, O'Leary KJ, Greysen SR, et al. Hospital ward adaptation during the …

… contributing factor. … Myers LC, Gartland RM, Skillings J, et al. An examination of medical malpractice claims …

This mixed-methods study assessed the barriers and facilitators to hospitals’ implementation of the MARQUIS toolkit, which supports hospitals in developing medication reconciliation programs. Leadership who responded to the survey/interview expressed limited institutional budgetary and hiring support, but hospitals were able to implement and sustain the toolkit by shifting staff responsibilities, adding pharmacy staff, and using a range of implementation strategies (e.g., educational tools for staff, EHR templates).

Using two case examples, this article discusses how the influences of cognitive biases in clinical decision-making contribute to diagnostic error and steps in the diagnostic process to avoid such errors, including using diagnostic checklists, conferring with teammates or peers, and continuously reassessing treatment response.

Teamwork Shared Mental Models (SMM) reflect the teams’ understanding of its members’ roles and interactions. This mixed-methods study examined teamwork-SMMs during discharge and described the differences of discharge teams with higher versus lower teamwork-SMMs. Teams with better teamwork-SMMs during discharge were more likely to report similar understanding of the patient’s situation, open communication and exchange of information, and team cohesion and resulted in more effective care delivery. Poor team-SMMs were characterized by divergent opinions regarding patient care plans, delays or gaps in communication, and team members operating independently and in isolation from their team.

The goal of medication reconciliation is to prevent unintended medication discrepancies at times of transitions in care, which can lead to adverse events. Implementing effective medication reconciliation interventions has proven to be challenging. In this AHRQ-funded quality improvement study, five hospitals implemented a standardized approach to admission and discharge medication reconciliation using an evidence-based toolkit with longitudinal mentorship from the study investigators. The toolkit was implemented at each study site by a pharmacist and a hospitalist with support from local leadership. The intervention did not achieve overall reduction in potentially harmful medication discrepancies compared to baseline temporal trends. However, significant differences existed between the study sites, with sites that successfully implemented the recommended interventions being more likely to achieve reductions in harmful medication discrepancies. The study highlights the difficulty inherent in implementing quality improvement interventions in real-world settings. A WebM&M commentary discussed the importance of medication reconciliation and suggested best practices.

Over the past decade, with the goal of improving both the educational experience and patient safety, the Accreditation Council for Graduate Medical Education has introduced regulations restricting resident duty hours and requiring graded supervision by faculty physicians. While many studies have evaluated how duty hour restrictions influence safety outcomes, the impact of different supervisory strategies has been less studied. Conducted on an internal medicine teaching service, this randomized controlled trial examined the effect of two supervisory strategies on patient safety and the educational experience for housestaff. Increased direct supervision (faculty physician physically present for duration of morning rounds, including patient care discussions and encounters with newly admitted and existing patients) was compared to standard supervision (faculty directly supervised residents only for new admissions, meeting later in the day to discuss existing patients). The study used a rigorous, previously developed methodology to track adverse event rates and found no significant difference in safety outcomes between the two groups. Residents perceived that greater supervision led to decreased autonomy in decision-making. Although the study evaluated only direct, in-person supervision, its findings demonstrate that—like reducing duty hours—increasing direct supervision of trainees does not necessarily translate to improving patient safety. The relationship between clinical supervision, education, and patient safety is discussed in a PSNet perspective.

Digital tools have the potential to improve diagnosis, patient self-care, and patient–clinician communication. This commentary argues that digital tools that alter diagnosis or treatment require examination to ensure safety. The authors provide recommendations such as involving experts in evaluating the tools, engaging information technologists, and continuous local review and assessment to identify and address risks associated with use of such tools in practice.

… Journal of graduate medical education … J Grad Med Educ … This survey study examined remote …

Insufficient follow-up with patients after hospitalization hinders identification of diagnostic or treatment errors. This commentary discusses the results of an intervention that incorporated a structured process for residents to gather information and reflect on patient status for postdischarge follow-up.