Individual-, team-, and systems-based factors can affect safety during childbirth. This article discusses several patient safety threats that can hinder the safety of vaginal birth after cesarean (VAC) deliveries in high population density areas, including staffing and resource limitations, cultural and human factors, and patient communication.

Delayed diagnosis and treatment of stroke leads to adverse patient outcomes. This cross-sectional study identified gender disparities in the treatment of patients with large vessel occlusion (LVO) acute ischemic stroke (AIS), with women being less likely to be routed directly to comprehensive stroke centers compared with men, despite having more significant stroke syndromes.

Missed diagnosis of aortic emergencies can result in patient death, therefore patients with presumed aortic syndromes may be transferred to aortic referral centers. Because interhospital transfers present their own risks, these researchers evaluated emergency transfers of patients who did not ultimately have a diagnosis of acute aortic dissection, intramural hematoma, penetrating aortic ulcer, thoracic aortic aneurysm, or aortic pseudoaneurysm. Approximately 11% of emergency transfers were misdiagnosed, secondary to imaging misinterpretation.

Studying the relationship between hospital volume, surgical volume, and clinical outcomes, past research in part led to recommendations for volume-based referral as a safety practice. However, the volume–outcome relationship may be limited to selected surgical procedures, suggesting that systematic volume-based referral is unnecessary. This study further examines these relationships by evaluating the impact of hospital surgical volume on preventable adverse events. The latter were measured using the AHRQ Patient Safety Indicators (PSIs), which have noted limitations as measures of safety. Nevertheless, investigators found that hospital volume for abdominal aortic aneurysm, coronary bypass graft, and Roux-en-Y gastric bypass were inversely related to PSI rates. Additional research to further evaluate the structural and process differences between outcomes and hospital volume may help identify potential safety solutions.

This study found evidence of a volume–outcome relationship for implantable cardioverter-defibrillator (ICD) placement. Physicians who performed only one or fewer ICD implantations per year had a significantly higher risk of complications.

The Leapfrog Group is a consortium of private and public employers who collectively purchase health care for more than 30 million Americans. Leapfrog recommends four evidence-based practices for implementation by hospitals: computerized provider order entry, intensivist coverage of critically ill patients, evidence-based hospital referral for high-risk patients, and adoption of the National Quality Forum's safe practices. This study found that hospitals that reported implementing at least one patient safety practice also provided slightly better care for myocardial infarction and congestive heart failure (as measured by publicly reported quality data), but not for pneumonia. The authors note that as the Leapfrog recommended practices are not directly tied to improving care quality for these specific conditions, implementation of Leapfrog patient safety practices likely indicates an overall commitment to providing higher-quality care.

Autopsies are rarely performed, despite a wealth of literature demonstrating that diagnostic errors are still frequently detected postmortem. The authors discuss the implications of this problem and potential solutions, including the establishment of regional high-volume autopsy centers.

This safety brief provides examples of collaboration, outsourcing, and technology to address medication safety issues in rural and small hospitals.

This study evaluated nearly 1500 hospitals to determine the relationship between their mortality rates and surgical volume for 12 selected procedures. Results include detailed tables of data and illustrative graphs for each procedure, suggesting a number of clear trends. Mortality associated with open-heart surgery, vascular surgery, transurethral resection of the prostate, and coronary bypass decreased with increasing volume at a given hospital. For other procedures, the mortality curve flattened at lower volumes, and some showed no relationship between volume and mortality. Although the authors recommend caution in interpretation and provide explanations for findings, they conclude that regionalization should warrant consideration for certain procedures.