The hospital-at-home (HAH) model allows patients to receive hospital-level care in their homes. This systematic review identified 25 articles (18 interventions) comparing outcomes of pediatric HAH care to standard in-hospital care. Hospital at home was not associated with increased hospital readmissions or adverse events. However, the quality of the studies was low to very low, and additional high-quality research is required.

Patient satisfaction surveys, unexpected event reports and patient complaints can each be used to improve patient safety. This radiotherapy service combined the three sources to make improvements in safety and quality. Results highlighted areas of strength (e.g., physical healing, kindness) and areas to improve (e.g., scheduling, comfort). Involving the patient in this way could lead to improvements in quality and safety.

Missed nursing care may result from inadequate nurse staffing and explain the relationship between nurse-to-patient ratios and patient outcomes. Research has shown that higher nurse staffing levels are associated with lower inpatient mortality and that reduced staffing increases the risk for postoperative complications. In this study, investigators examined data from more than 400,000 surgical patients from 300 hospitals in 9 countries as well as survey responses from 26,516 nurses. They found a significant association between nurse staffing and missed nursing care with 30-day risk-adjusted postoperative mortality. The authors conclude that measuring missed nursing care may help identify patients at greater risk for adverse outcomes earlier in their course. A past WebM&M commentary highlighted important issues associated with nurse staffing ratios.

Researchers analyzed patient discharge data and hospital characteristics, as well as patient and nurse survey data, across adult acute care hospitals in six European countries. After adjusting for hospital and patient variables, they found that hospitals in which nursing care was provided to a greater degree by skilled nurses had lower odds of mortality. The authors argue against replacing professional nurses with nursing assistants and suggest that doing so may compromise patient safety by increasing preventable deaths.

… supporting providers involved in patient safety events. … Van Gerven E, Bruyneel L, Panella M, et al. Psychological …

Clinicians who are involved in an adverse event often experience significant emotional consequences, leading to the term "second victim." This survey of physicians and nurses in Belgium examined the relationship between involvement in an error in the past 6 months and clinicians' emotional state, risk of engaging in high-risk behaviors, and work–life balance. Involvement in an error was strongly correlated with burnout, potentially harmful medication use, and plans to leave the health care field. The cross-sectional nature of the study makes it difficult to discern causality, and other studies show that burnout increases the risk of committing an error. Nevertheless, this study adds to a growing body of literature demonstrating that errors have long-lasting harmful effects for clinicians. A qualitative study explored how clinicians recover from being involved in errors, and a WebM&M commentary describes ways that organizations can help clinicians in the recovery process.

Prior studies have found that unplanned transfers to the intensive care unit are generally not preventable. This study challenges that viewpoint, finding that preventable adverse events may have contributed to the need to escalate care in many patients.

This retrospective cohort study across nine European countries revealed that higher patient–nurse staffing ratios increased the likelihood of inpatient mortality. A larger proportion of nurses with bachelor's degrees decreased this risk, consistent with previous research that found a relationship between nurse education levels and patient outcomes. This finding emphasizes the importance of maintaining an adequately staffed and trained nursing workforce to support safety in hospitals.

Nurses are frequently forced to prioritize tasks during busy shifts, leading to some nursing care being left undone. In this multinational European study, nurses most frequently omitted time-intensive but critical practices such as talking with, educating, and providing comfort for patients.

Focusing on health care providers as the second victims of adverse events, this review explores the prevalence of second victims, the impact of the error, and individual coping strategies.

Clinicians who are involved in a medical error are at increased risk for psychological complications and burnout; this phenomenon has resulted in clinicians who are involved in errors being called second victims. This review identified several strategies that organizations can use to support second victims, both at an individual and organizational level. An important part of supporting second victims appears to be providing immediate access to assistance, as in a second victim rapid response team. The effects of errors on health care providers are discussed in this AHRQ WebM&M perspective.

A considerable body of literature documents widespread variations in outcomes for patients hospitalized at different hospitals for similar conditions. Care pathways are intended to improve outcomes by standardizing use of evidence-based practices, and a surgical pathway was recently shown to markedly reduce both complications and postoperative mortality. However, this survey of obstetric care pathways for normal deliveries at Belgian hospitals found that the 17 pathways analyzed varied widely and did not consistently apply evidence-based practices to prevent postpartum complications. A devastating series of preventable complications during delivery, which led to the death of an infant, is discussed in this classic commentary, and lessons learned from the case have been incorporated into a video widely used for teaching purposes.

Seminal studies in the United States have shown strong associations between nurses' working conditions and patient safety, with high patient-to-nurse ratios and greater patient turnover being linked to increased mortality. This multinational survey of nurses and patients found that improved nurse work environments and reduced patient-to-nurse ratios were linked to better perceptions of quality and patient satisfaction. Moderately strong correlations were found between patient satisfaction and nursing reports of care quality, although there were wide variations in both measures across different countries. This study lends additional support to the view that improving the work environment for nurses can strengthen patient safety.

Many patient safety studies estimate lives saved to quantify the effect of safety interventions. This article enumerates the statistical techniques needed to derive accurate estimates of mortality benefits.

This systematic review was unable to estimate the incidence and preventability rate of adverse events that precipitate intensive care unit admission due to study heterogeneity. The authors discuss the recommended prevention strategies, including rapid response systems, but also raise concerns about the limited evidence surrounding these strategies.

Use of administrative datasets to identify adverse events can be problematic, as these datasets are generally compiled for billing purposes and may lack specificity about clinical care processes. This study, conducted in Belgium, confirmed that an administrative dataset alone had only moderate accuracy for identifying inpatient adverse events.

Increased nurse staffing on postoperative general wards—but not in the intensive care unit—was associated with reduced mortality for cardiac surgery patients.