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The COVID-19 pandemic and dentistry: parts 1 and 2.

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Coulthard P, Thomson P, Dave M, et al. Br Dent J. 2020;229:743-747; 801-805.

The COVID-19 pandemic suspended routine dental care. This two-part series discusses the clinical challenges facing the provision of routine dental care during the pandemic (Part 1) and the medical, legal, and economic consequences of withholding or delaying dental care (Part 2).

Accurate measurement In California's safety-net health systems has gaps and barriers.

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Khoong EC, Cherian R, Rivadeneira NA, et al. Health Aff (Millwood). 2018;37:1760-1769.

California's Medicaid pay-for-performance program requires safety-net health care systems to report and improve upon diverse ambulatory safety measures. Researchers found that participating safety-net hospitals struggled to report accurate data. Systems had more success improving metrics that placed patients at risk of life-threatening harm when compared to metrics that required longer term follow-up or patient engagement.

Patient safety beyond the hospital.

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Gandhi TK, Lee TH. N Engl J Med. 2010;363:1001-3.

This commentary discusses challenges for patient safety improvement work in the ambulatory setting along with recommendations for addressing them.

Patient Safety.

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Sixth Report of Session 2008–09. House of Commons Health Committee. London, England: The Stationery Office; July 3, 2009. Publication HC 151-I.

This government report analyzes the National Health Service's efforts to enhance patient safety and recommends improving certain areas, such as adopting technology, analyzing failure, and ensuring both practitioner education and adequate staffing.

In Conversation with...Dean Schillinger, MD

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March 22, 2009

Dean Schillinger, MD, is a Professor of Medicine at University of California, San Francisco, Director of the UCSF Center for Vulnerable Populations, and Chief of the California Diabetes Prevention and Control Program. His role as a practicing clinician at a safety net hospital (San Francisco General Hospital) has put him in a unique position to pursue influential and relevant research related to health literacy and improving care for vulnerable populations.

Windows into Safety and Quality in Health Care 2008.

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Sydney, Australia: Australian Commission on Safety and Quality in Health Care; 2008. ISBN: 9780980346275.

This report compiles public and private data to provide insight into the quality and safety of patient care in Australian hospitals.

ISMP medication error report analysis.

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Smetzer JL; Cohen MR.

This monthly selection of reports includes errors involving epidural medication administered intravenously and mistaken reuse of discontinued drugs.

Disuse of system is cited in gaps in soldiers' care.

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Urbina I; Nixon R.

This article reports on the inconsistent use of the Department of Defense electronic medical records system and how this has led to medical errors and delays in care for US veterans.

Alleged kidnapper agrees to extradition.

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Blaney B; Associated Press

This article reports on the abduction of a newborn by an individual masquerading as a hospital employee. Infant abduction is one of the patient safety "never events" defined by the National Quality Forum.

Fumbled Handoff

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March 1, 2004

Due to a series of incomplete signouts, information about a patient's post-operative leg pain and chest discomfort is not conveyed to the primary team. A PE is discovered post-mortem.

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