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Whether or not word selection during handoffs affects clinician anxiety and diagnostic uncertainty remains unknown. In this study involving medical students, researchers found that use of the word "hypothesis" compared to the word "diagnosis" when describing a hypothetical handoff from the emergency department to the inpatient setting was associated with increased self-reported anxiety due to uncertainty.

Clinical staff often fail to call rapid response teams to evaluate deteriorating patients, even when objective criteria for calling the team are met. This qualitative study of physicians and nurses at an Australian hospital found that an impaired culture of safety can result in failure to use the rapid response team when appropriate and can also lead to using the team as a workaround to compensate for poor interdisciplinary communication.

In response to a recent investigation raising concerns about inaccurate reporting of wait-time data, this commentary relates barriers to improving patient safety, such as overuse of performance measures. The authors describe approaches to augment safety, such as narrowing down performance measures to address the most significant concerns and engaging private health care organizations in improvement projects.

Silence and poor communication are known threats to patient safety. Despite efforts to promote teamwork and develop shared tools for communication, there are persistent gaps between nurse and physician practices. This study surveyed nurses and physicians working in labor and delivery units and discovered significant differences in their perceptions of patient harm associated with various clinical scenarios. These differences in patient harm ratings were the greatest predictor of speaking up, suggesting that differences in clinical assessment may serve as a useful target for intervention. The authors discuss the negative impact of environments where mental models are not shared, conflict is poorly managed, and disruptive behaviors stifle open communication. A past AHRQ WebM&M commentary discussed a case of "silence" when members of the operating room team were reluctant to speak up to a senior surgeon.

This commentary identifies the contributing factors in a case of patient suicide during the course of year-end resident turnover.

The majority of individual errors are due to failure to perform automatic or reflexive actions. A major risk factor for these "slips" is being interrupted or distracted while performing a task. This review examined the literature on the incidence, risk factors, and effects of interruptions in several clinical settings, ranging from outpatient clinics to the operating room. Although distractions are common and may be associated with increased risk for error, particularly if they occur during medication administration or signout, the authors point out that many interruptions may be necessary to communicate urgent clinical information. They argue for complexity theory–based research to delineate the harmful and beneficial aspects of interruptions, rather than for interventions that seek to simply eliminate interruptions. Checklists have been widely adopted as a means of preventing errors of omission, which may be precipitated by interruptions.

The majority of hospitalized patients in this study could not name their hospital physicians and had significant misconceptions of their plan of care.

Pediatric residents felt comfortable caring independently for patients, but reported difficulty working within a team environment, in this study that used the Safety Attitudes Questionnaire to assess safety culture.

Discontinuity is an unfortunate but inevitable reality of medical care, as no clinician can be available around the clock. This study surveyed geriatric patients to examine patients' perceptions of discontinuity in the outpatient setting. Although a relatively small proportion of patients reported that they would feel unsafe if seeing someone other than their primary physician, those who did report concerns tended to have more complex medical problems. This feeling may be well founded, as a recent study documented that communication between providers caring for the same patient is often poor. The safety effects of discontinuity have been most studied in the hospital, and strategies have been developed to improve the transmission of information between inpatient providers.

This study found that more than half of physicians surveyed engaged in questionable documentation practices, such as recording information that they did not personally obtain or writing notes on patients not seen or examined. The findings raise concern about professionalism broadly but also about the current educational environment for trainees, role modeling of documentation behaviors, and the greater impact of billing and medical-legal influences on documentation practices. These changing factors may in part explain why the findings also suggest that questionable practices were more common among younger providers, who may be a product of the changed environment outlined in recent years.