Vulnerable populations, such as those with limited English proficiency, minoritized race or ethnicity, migrant populations, or patients qualifying for public insurance, may be at higher risk for adverse health events. In this review, researchers sought to identify frequency and causes of diagnostic error of vulnerable populations presenting to the emergency department with cardiovascular or cerebrovascular/neurological symptoms. Black patients presenting with cardiovascular symptoms had significantly higher odds of diagnostic error. Other demographic factors did not show similar associations, nor did studies of patients with cerebrovascular/neurological symptoms.

Various factors – including organizational, interpersonal clinician, and patient factors – can contribute to diagnostic errors and delays. This survey of 220 clinicians explored the perceived frequency of different factors contributing to diagnostic errors or diagnostic delay. Findings suggest that system and processes, care team interactions, provider factors, cognitive factors, and patient factors were perceived to contribute to diagnostic error and delay with similar frequency.

Identifying and reducing diagnostic errors remains a critical patient safety concern. This prospective study asked clinicians if they perceived that a diagnostic error played a part in rapid response team activations or unplanned admissions to the intensive care unit. Clinicians reported that 18% of acute care patients experienced diagnostic errors.

Diagnostic errors and delays continue to be a widespread patient safety concern in hospitalized patients. Researchers conducted focus groups with key clinician stakeholders to determine factors that contribute to diagnostic error and delay. Clinicians indicated that organizational, interactional, clinician, and patient factors all interact to cause errors and delays. These diverse factors must be considered when implementing interventions to reduce diagnostic errors and delays.

Simulation has been adopted as a valuable teaching tool in health care. This commentary reviews mastery learning theory at the individual and system levels and suggests that it can be enhanced with simulation to engineer effective processes at the organizational level.

This systematic review found that patients who experience adverse events in intensive care units (ICUs) have significantly longer hospital and ICU stays. According to this study, the effect on mortality is less clear as the evidence linking adverse events to ICU deaths have been mixed and unreliable.

Recent research has examined residents' perceptions about the impact of duty hour restrictions. In this survey, surgical interns reported decreased patient care coordination, continuity of care, and time spent in the operating room, with no significant improvements in quality of life or reduced risk of burnout.

The duty hour regulations for resident physicians implemented in 2011 were intended to improve patient safety by minimizing resident fatigue. Teaching faculty evinced skepticism about the effect of these regulations from the outset, mirroring the frosty reception given to the 2003 regulations. Even residents themselves—who the regulations are intended to benefit—doubt the rules will achieve their goal. The majority of surgical residents surveyed in this study believe the regulations will result in greater discontinuity and more fragmented patient care and will harm their overall educational experience. Another recent survey of residents in multiple specialties noted similar findings, with the majority of residents disapproving of the new regulations. A systematic review of the 2003 duty hour regulations found no overall improvement in patient safety or educational outcomes after the rules were implemented.

General surgery residents strongly preferred signing out patients in person rather than by videoconferencing or other electronic modalities, but in this simulation study, signout accuracy was suboptimal in all methods tested.

Based in part on its success in aviation, simulation technology has emerged as a new method for training health care professionals. While certain settings have demonstrated benefits from simulation training, there is controversy about whether its impact exceeds that of traditional didactic experiences. This systematic review analyzed results from more than 600 studies that evaluated simulation training programs. Overall, there were significant associations between simulation training and improved outcomes of knowledge, skills, and behaviors. Moderate effects on patient-related outcomes were also noted. A past AHRQ WebM&M point–counterpoint discussion debated the benefits of simulation over classroom-based training programs.

This survey of internal medicine, pediatrics, and general surgery residency program directors found strong support for many components of the recently proposed duty-hour regulations, including the overall limit of 80 hours per week and the requirement for on-site supervision of first-year residents. However, most directors disagreed with the proposed 16-hour maximal shift length for interns, and only a few of the programs surveyed already enforce such a limit.

Bowel perforation after colonoscopy occurred in fewer than 1 of 1000 patients, but was associated with high rates of morbidity and mortality.