In this simulation study, emergency department physicians completed standardized tasks using actual electronic health records (EHRs) at four sites. Even though two sites used Epic and two used Cerner EHRs, the number of clicks per task, time to task completion, and error rates varied widely. The authors highlight the importance of local implementation decisions as well as design and development in supporting usability and safety of electronic health records.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … Poor usability of electronic health …

Root cause analysis (RCA) is a process frequently employed by health care institutions to understand the sequence of events leading to an adverse event or near miss. Experts have previously highlighted flaws with the RCA process and suggested ways to improve it. In this study, researchers reviewed 302 RCAs and concluded that many of the proposed solutions were weak, consisting largely of educational interventions, changes to processes, and enforcing policy. A recent Annual Perspective explores ongoing problems with the RCA process and sheds light on opportunities to improve its application in health care.

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … Resilience is a characteristic that …

… of the American Society for Healthcare Risk Management … J Healthc Risk Manag … The authors reviewed 334 root cause …

This commentary highlights elements of human factors that can be applied to improve efficiency and safety in health care.

This survey of emergency medical services (EMS) personnel found that lower perceived safety culture was associated with an increased risk of adverse events in patients and an increased risk of injury in EMS providers.

This survey found that the perception of safety culture varied widely among prehospital emergency medical service agencies, with air medical emergency services tending to report slightly more positive views on safety.

This qualitative study found that while safety issues in pediatric prehospital care are not uncommon, most go unreported.

… journal of the American College of Medical Quality … Am J Med Qual … This article reports on the development and …

This article describes how applying a just culture and systems approach to adverse events may help change the "blame-and-shame" mentality in emergency medical service provision.

This study used focus groups, in-depth interviews, and event reporting methods to conclude that Emergency Medical Services (EMS) providers are concerned about existing system issues that require improvement strategies, and about the safety culture in which they work.

This study of closed malpractice claims against prehospital emergency medical services found that clinical management was an infrequent source of malpractice allegations, trailing emergency vehicle accidents and patient handling mishaps.

This study used link analysis techniques in observing that face-to-face communication was the most common mode among different provider types in an emergency department. The charge nurse was observed to be the center of communication while interruptions were a common event for both physicians and nurses.

Adoption of smart infusion pump technology was intended to improve medication safety, but past reports describe the ability of nurses to create work-arounds. This study examined preventable intravenous adverse drug events (IV-ADEs) and discovered that only 4% could be intercepted by a smart pump. Investigators reviewed medical records, both before and after adoption of smart pumps, to draw these conclusions. They also provide a qualitative analysis of errors causing preventable IV-ADEs and propose solutions that would improve smart pump technology.

This study discovered that adverse drug events (ADEs) associated with intravenous administration led to increased hospital costs and length of stay, but only in academic centers. Investigators conducted chart reviews for more than 4600 patients in 5 different intensive care units, and present findings from nearly 400 ADEs identified. The majority of events led primarily to temporary physical injuries. In academic settings, the events were associated with more than $6600 in costs and a 4.8 day longer length of stay. The most notable finding was the lack of such differences in nonacademic settings. The authors discuss the differential findings in academic versus nonacademic settings, including how the limitations of their study design may have contributed.

This study used simulated resuscitation scenarios and found that a confusing user interface limited paramedics' ability to properly use two common defibrillator models. A related editorial discusses the challenge of uniting patient safety principles and usability.

… journal of the American College of Medical Quality … Am J Med Qual … The authors discuss the nature of medical error …