Digital health tools are increasingly used to support the delivery of safe healthcare. This scoping review characterized 13 articles exploring the use of digital interventions intended to support patient safety among pediatric patients and their parents. Interventions were commonly delivered through mobile applications, web-based technologies, computer kiosks, and electronic health records, and focused on patient safety event prevention and risk management.

Surgical safety checklists (SCC) are utilized around the world, but checklist completion at the operating room level remains inconsistent. This review summarizes facilitators and barriers to completion. Resistance or endorsement at the individual surgeon level remains a significant factor in SSC completion. Early inclusion of frontline staff in evaluation and implementation supported increased use.

Psychological safety is an important principle in identifying problems and improving patient outcomes. This narrative review highlights five best practices to foster psychological safety in radiology residencies – (1) establish clear goals and educational strategies, (2) build a formal mentoring program, (3) assess psychological safety, (4) advocate for radiologists as educators, and (5) support non-radiology staff. Although the review focuses on radiology residency programs, these strategies can be adapted to any residency program.

In situ simulation can reveal latent safety threats before they cause harm. This review identified 15 studies of in situ simulations conducted in the emergency department including simulations conducted prior to opening new facilities and to address emerging COVID-19 concerns. The most commonly identified safety threats were related to equipment and team communication.

Morbidity and Mortality Conferences (MMC) have a long history in medical education and error analysis. This review summarizes MMC best practices to optimize format and design to advance trainee education and format. Four overarching themes emerged, including formal preparation in advance of the MMC, a balance of presentation and discussion, formal channels for quality improvement and education, and an emphasis on safety culture.

An increasing strategy to reduce adverse drug events (ADE) is pharmacist medication review, typically involving other members of the care team. This qualitative review summarizes randomized studies of interventions with multidisciplinary care teams to reduce ADE. Most interventions were time-intensive (1- to 2-hours), including four steps (data collection, appraisal report, multidisciplinary medication review, follow up). Most teams consisted of a pharmacist, physician, and nurse, although some included other providers such as psychologists or social workers.

Achieving high reliability remains difficult for many organizations. This article provides a brief history of the concept of high reliability organizations (HROs) and key features of high reliability culture, such as fostering trust and respect among teams and creating systems and processes to elicit feedback/reflections and identify opportunities for improvement. The authors discuss these concepts in the setting of anesthesiology and perioperative care.

Failure to rescue (FTR) quality metrics measure the ability of healthcare teams and hospitals to prevent mortality following a major complication. This systematic review included 12 studies and examined how FTR has been used in neurosurgical populations. The authors discuss several modifications to existing FTR definitions to better suit neurosurgical patients, such as incorporating measures of baseline frailty.

Autopsies and coronial investigations provide important learning opportunities. In the UK, coroners may issue Prevention of Future Death reports (PFD) when they determine taking actions could prevent future deaths. This review summarizes studies that use PFDs to investigate patient safety, such as medication- or diagnosis-related deaths. The authors conclude the impact of PFDs could be strengthened by improving the reporting and dissemination system and enforcing the requirement that hospitals submit a response.

Leadership behaviors have an important impact on the workforce and work environment in both positive and negative ways. This review summarizes how toxic leadership impacts the nursing workforce and patient safety. Within the patient safety theme, toxic leadership was significantly associated with increased falls, nosocomial infections, and medication errors.

Healthcare workers who are involved in patient safety incidents and experience adverse psychological or emotional outcomes are often referred to as second victims. This systematic review and meta-analysis found that 58% of healthcare workers in intensive care unit (ICU) settings have experienced second victim outcomes, including guilt, anxiety, anger at oneself, and decreased self-confidence. The review also found that one in five individuals took longer than 12 months to recover or did not recover at all, underscoring the importance of organizational support programs for healthcare workers involved in patient safety incidents.

Healthcare leadership walkarounds (LWs) involve organizational leaders visiting hospital wards to hear directly from frontline staff about concerns and what is going well. This systematic review describes the impact of LWs on organizational and patient outcomes. Most studies (11 out of 12) measured organizational or clinical outcomes. Organizational outcomes included staff perception of safety culture, near miss reports, teamwork, and feeling heard. Only one study investigated the association between LWs and clinical outcomes; in that study, catheter-associated urinary tract infections decreased following implementation of LW.

Cognitive biases can impact the type of care a patient receives and their subsequent outcomes, particularly in the emergency department which operates under time and resource constraints. This review identified 18 studies on cognitive biases in emergency physicians and nurses. Most studies focused on implicit bias and on physicians. Of the five studies focused solely on nurses, all assessed bias in emergency department triage.

Research has shown a robust safety culture improves patient outcomes, reduces length of hospital stay, and increases patient and staff satisfaction. As such, safety culture is increasingly being measured by healthcare organizations. This review sought to identify the factors measured by safety culture instruments in hospitals. The Hospital Survey on Patient Safety Culture and Safety Attitudes Questionnaire were the most frequently used instruments. Important factors include organizational, professional, and patient and family participation, although none of the instruments measured all three.

Organizational incident reporting allows for investigation of contributing factors and formation of improvement recommendations, but some recommendations are weak (e.g., staff training) and do not result in system change. This review found 4,579 recommendations from 11 studies, with less than 7% classified as "strong". There was little explanation for how the recommendations were generated or if they resulted in improvements in safety or quality of care. The authors contend additional research into how recommendations are generated and if they result in sustained improvement is needed.

Cognitive aids such as mnemonics can help improve process reliability and promote patient safety. Based on an initial scoping review, this article describes a proposed taxonomy for clinical handoff mnemonics and their clinical processes and functions, which could help clinical teams design handoff mnemonics that best fit their workplace.

Resilience in healthcare focuses on enabling individuals and teams to respond to emergent problems without compromising safety. This review-of-reviews examines the definitions of resilience across the hierarchical levels of healthcare (e.g., individual, team, organizational, community). The authors describe an interdisciplinary, cross-sectoral, multi-level conceptual framework for healthcare resilience which includes resilience activities before, during, after, and across events.

Telehealth can expand patient access to care and improve patient experience. This integrative review including nine studies explored the tele-palliative care options available for caregivers, factors influencing the sustainability of tele-palliative care interventions, and patient safety considerations (e.g., data security, communication challenges).

Morbidity and mortality conferences offer important opportunities for healthcare teams to discuss adverse events, learn from errors, and improve patient safety. This systematic review examined beneficial aspects of perioperative team-based morbidity and mortality (TBMM) conferences. The authors found that TBMM conferences generally led to improvements in patient safety, quality improvement, and educational outcomes and that certain factors (case preparation, standardized presentation format, effective facilitation) increase TBMM benefits.