Casciato DJ, Thompson J, Law R, et al. J Foot Ankle Surg. 2021;60:1152-1157.
The "July Effect" refers to the idea there may be an increase in medical errors in July when newly graduated medical students begin their residencies. In this retrospective chart review of podiatric surgery patients, researchers did not find any statistically significant difference in patient outcomes between surgeries performed during the first quarter of residency (July-September) and the last quarter (April-June). Results suggest robust resident training programs can limit errors that may otherwise occur during this time of transition.
Roberts SCM, Beam N, Liu G, et al. J Patient Saf. 2020;16:e317-e323.
The increase in maternal morbidity and mortality is a priority patient safety issue. This study compared miscarriage treatment-related morbidity and adverse events among hospitals, ambulatory surgery centers (ASCs), and office-based settings. Although there were slightly more events in hospitals than ASCs or office-based settings, study findings do not support limiting miscarriage treatment to a particular setting.
Sweet W, Snyder D, Raymond M. J Healthc Risk Manage. 2020.
This article describes one health system’s experience implementing an infection prevention program into risk management in an outpatient setting. Over a two-year period post-implementation, the system identified and corrected high-risk practices, increased compliance to device guidance, increased efficiency with the use of central sterile processing departments, and developed a staff competency training structure.
de Lima A, Osman BM, Shapiro FE. Curr Opin Anaesthesiol. 2019;32.
Office-based anesthesia (OBA) is being performed more commonly internationally. This narrative literature review updates the evidence related to the safety of OBA and makes recommendations for safe practices including; medical directors to be responsible for evidence-based policies, OBA safety and patient checklists emergency procedures, physical setting requirements, pharmacological management, preoperative procedures, airway management and others. The authors identify that lack of consistent regulations and incomplete protocol standardization is problematic.
Young S, Shapiro FE, Urman RD. Curr Opin Anaesthesiol. 2018;31:707-712.
Office-based surgery is increasingly common, despite concerns regarding its safety. This review summarizes the literature on ambulatory surgery outcomes and identified risk factors such as case complexity, patient comorbidities, and anesthesia use. Few studies examined anesthesia use in dental care.
Opioid deaths are a major public health and patient safety hazard. This multimodal, health care system-level intervention to reduce opioid overprescribing consisted of changes to the electronic health record, patient education, and provider education and oversight. Opioid prescribing decreased substantially (58%) systemwide with no discernible decrement in patient satisfaction.
Karamnov S, Sarkisian N, Grammer R, et al. J Patient Saf. 2014;13:111-121.
The recent death of comedienne Joan Rivers, which followed a cardiac arrest during a routine throat procedure, has brought national attention to the potential safety hazards of office-based procedural anesthesia. This retrospective study examined adverse events associated with moderate procedural sedation performed outside of the operating room at a tertiary medical center. Adverse events were relatively rare, with only 52 safety incidents identified out of more than 140,000 cases over an 8-year period. The most common harm was oversedation leading to apnea and requiring the use of reversal agents or prolonged bag-mask ventilation. Women were found to be at particularly increased risk for adverse events including oversedation and hypotension. These findings suggest that a combination of patient and procedural characteristics may help risk stratify patients, allowing for appropriate responses such as increased monitoring and staffing for patients likely to experience sedation-related complications. A previous AHRQ WebM&M perspective described office-based anesthesia as the "Wild West" of patient safety.
This survey revealed that anesthesiologists in New York commonly use unsafe injection techniques, such as accessing a single medication vial for multiple patients. Resident physicians reported improper practices more frequently than attending physicians.
Mueller BU, Neuspiel DR, Fisher ERS, et al. Pediatrics. 2019;143.
This updated policy statement from the American Academy of Pediatrics reviews the epidemiology of medical errors in children, examines unique issues in safety for pediatric patients, and discusses specific approaches to improving safety in pediatrics. The article emphasizes the responsibility of pediatricians to be familiar with patient safety concepts and techniques, and the importance of establishing a culture of safety in both inpatient and outpatient settings. The article concludes with a series of specific recommendations for advancing the science of patient safety within the field of pediatrics.
Kallen AJ, Mu Y, Bulens S, et al. JAMA. 2010;304:641-8.
The overall rate of health care–associated infections caused by methicillin-resistant Staphylococcus aureus declined significantly from 2005 to 2008, perhaps as a result of more aggressive prevention strategies.
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