Healthcare organizations use trigger tools to identify potential errors or adverse events in the electronic health record (EHR), measure the frequency of errors, and track safety improvements. Three hospitals in Germany conducted a feasibility study of implementing the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) in two general surgery units and one neurosurgery unit. Twenty-two feasibility criteria were developed (low-, moderate-, problematic-level of challenge) which may help guide successful implementation of the GTT.

Correctly reporting, interpreting, and comparing patient safety culture (PSC) survey findings is critical to improving patient safety in hospitals. Nearly 1,800 physicians and nurses were surveyed using the Hospital Survey on Patient Safety Culture (HSOPS) to examine the influence of gender, profession, and managerial function on perception of patient safety culture. Results indicate that profession and managerial function had significant direct effects, while gender had indirect effects, on the Overall Perception of Patient Safety dimension. Hospitals should take these characteristics into account when interpreting PSC survey results.  

Effective teamwork is a critical component of care coordination and patient safety. This systematic review assessed the relationship between teamwork processes and clinical and process outcome measures in an acute care setting. Outcome measures included both clinical outcomes, such as postoperative infection rates, and process measures, such as adherence to checklists intended to prevent patient harm. The authors found that teamwork was positively correlated with both outcome and process measures, regardless of the characteristics of the team or task.

Safety culture is traditionally measured from the health care team's perspective. Researchers used a large online survey to develop and validate an 11-item scale to measure patients' perception of safety culture. A recent Annual Perspective explored the growing field of patient engagement in safety.

Failure mode and effect analysis is a tool commonly used to proactively assess the reliability of health care processes and workflows. The authors describe the application of failure mode and effect analysis to identify failure modes in the dispensing of medications in the community pharmacy setting.

This narrative review found that failure mode and effect analysis and sociotechnical probabilistic risk assessment have both been applied to medication dispensing. These methods have led to corrective actions that enhance medication safety. The authors recommend wider use of these tools across inpatient and outpatient health care settings.

Interruptions are known to contribute to medication administration errors. This pre–post study found that nurses experienced fewer interruptions and made fewer medication errors following the introduction of a separate medication room. These results demonstrate how changing the work environment can promote safety.

Teamwork and clinician well-being have important implications for patient safety. Researchers conducted a systematic review of the literature and found evidence supporting independent relationships between teamwork, clinician well-being, and patient safety. The authors propose a framework that addresses current limitations and suggest that further research is needed to better understand the causal relationships between the three concepts.

Emotional exhaustion is a component of burnout—a critical patient safety issue. Teamwork promotes resilience and thus may protect against burnout and promote patient safety. However, it is unclear how teamwork, burnout, and patient safety interact in a safety culture. This prospective study of critical care interprofessional teams found that clinicians' emotional exhaustion affects teamwork, which leads to worsening clinician reports of patient safety. The authors suggest addressing clinicians' emotional exhaustion prior to team training in order to best augment patient safety in the intensive care unit. A PSNet interview discusses strategies to enhance clinicians' emotional resilience.

This Swiss study sought to determine the relationship between elements of clinician burnout and mortality, length of stay, and ratings of patient safety. The authors found that clinicians demonstrating symptoms of burnout had lower perceptions of patient safety in the intensive care unit. However, higher levels of burnout among clinicians were not linked to clinical outcomes.

This survey examined the barriers to incident reporting faced by nurses and physicians in Switzerland.

This study conducted in the United Kingdom indicates that supportive, safety-oriented behaviors by senior nurses are associated with improved performance on safety indicators.

Direct observation of postoperative handoffs revealed that clinicians' subjective impressions and concerns were a critical component of a high-quality transfer of care and were considered more important than the transmission of standard clinical information.

Reforms that limited duty hours for resident physicians stimulated efforts to enhance the safety of patient handoffs, and innovative approaches to improving safety have drawn on methods from other industries (including automobile racing). However, this systematic review of nursing and physician handoffs found little high-quality research on the effectiveness of specific handoff methods. Although use of standardized handoff sheets appeared to improve the quality of handoffs, the authors were unable to find evidence linking any handoff interventions to better patient outcomes. A case of poor handoff communication that led to an avoidable surgical procedure is discussed in this AHRQ WebM&M commentary.

Exploring team mental models in health care, this review identifies gaps in the evidence base that should be addressed to improve its application.

This Swiss survey identifies key organizational factors that help hospitals establish a comprehensive clinical risk management service.

… the importance of dedicated pre-handover time to foster effective patient handoffs . …

Situational awareness refers to the degree to which perception matches reality. This study assessed situational awareness of intensive care unit teams through direct observation of team rounds and assessment of the degree to which team members were able to anticipate clinical deterioration.

This review explores surgeon intraoperative leadership behaviors and how they affect team performance and safety.

This review explored patient transfer in hospitals to identify common areas for communication failures during handoffs.