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.

Patient engagement is predicated on respect for patients and a culture that enables involvement. This commentary spotlights the need to integrate patient dignity into policy and research in support of lasting patient safety improvement. The authors suggest that building the concept of dignity into safety work at the organizational level can prevent unintended consequences.

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.

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.

This study found that 14% of patients vulnerable to adverse drug events (based on age and comorbidities) received a high-risk prescription in the past year, particularly for long-term medications. While many prescriptions were not deemed inappropriate, differences in prescribing patterns were noted and may provide opportunities for prevention.

This survey found significant differences between American and British physicians regarding several aspects of patient safety, including appropriateness of error disclosure, tolerance for disruptive behavior, and prior experience with formal patient safety training.