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Brenner MJ, Boothman RC, Rushton CH, et al. Otolaryngol Clin North Am. 2021;55.
This three-part series offers an in-depth look into the core values of honesty, transparency, and trust. Part 1, Promoting Professionalism, introduces interventions to increase provider professionalism. Part 2, Communication and Transparency, describes the commitment to honesty and transparency across the continuum of the patient-provider relationship. Part 3, Health Professional Wellness, describes the impact of harm on providers and offers recommendations for restoring wellness and joy in work.
Chuang E, Cuartas PA, Powell T, et al. AJOB Empir Bioeth. 2020;11:148-159.
Before the emergence of COVID-19, the National Academy of Medicine had provided guidance on the reallocation of scarce medical resources – including ventilators – during extreme situations. Based on focus groups and key informant interviews conducted in 2018, this study sought to understand potential barriers arising from ethical conflicts to the implementation of these guidelines for ventilator allocation in the event of resource scarcity. Participants anticipated challenges reconciling this protocol with their roles and identities as health care providers, as well as concerns about emotional consequences, and fear of legal repercussions. These concerns raise questions about the performance of such a protocol in disaster scenarios and highlight the need for disaster preparedness drills and training.
Hart WM, Doerr P, Qian Y, et al. AMA J Ethics. 2020;22:E298-E304.
Communication has become a foci of improvement efforts across the spectrum of patient safety. This article discusses a surgical complication incident that illustrates the importance of transparency, disclosure and collaboration as elements of a successful approach to communication that can successfully manage the impact of an adverse incident.
Nowotny BM, Davies-Tuck M, Scott B, et al. BMJ Qual Saf. 2021;30:186-194.
After a cluster of perinatal deaths was identified in 2015, the authors assessed 15-years of routinely collected observational data from 7 different sources (administrative, patient complaint and legal data) preceding the cluster to determine whether the incidents could have been predicted and prevented. The extent of clinical activity along with direct-to-service patient complaints were found to be the more promising for purposes of potential predictive signals. The authors suggest that use of some routinely collected data of these types show promise; however, further work needs to be done on specificity and sensitivity of the data and to gain access to comparator data is needed.
Chiu RG. AMA J Ethics. 2019;21:E553-558.
Although disclosure of medical error to patients is difficult, it is an ethical responsibility. This article discusses situations involving patients who are incapacitated and unrepresented but have no surrogate present to assist in communication and care coordination. Despite this challenge, the author argues that the clinician and organization still have the responsibility to document what happened, communicate what is known, and rectify the mistake.
Sheetz KH, Dimick JB. JAMA. 2019;321:1971-1972.
The FDA recently raised awareness of the potential risks associated with the use of robotic-assisted surgical devices in mastectomies or cancer-related care. This commentary spotlights how payers, hospitals, and clinicians can prevent harm related to robotic surgical device use. Strategies to improve safety include enhanced credentialing, device-specific training, and informed consent. A WebM&M commentary discussed an incident of harm associated with robotic-assisted surgery.
Mello MM, Livingston EH. JAMA. 2017;318:233-234.
Scheduling overlapping procedures is perceived as risky, despite lack of robust evidence regarding its impact on patient safety. This commentary explains that the practice is primarily detrimental to the physician–patient relationship and that building trust is a key strategy to manage this concern. The authors suggest transparency with patients about scheduling practices and hospital oversight to ensure accountability would assist in establishing the trust in overlapping surgeries.
Rosenbaum L. N Engl J Med. 2015;373:1385-8.
This commentary explores challenges to monitoring and rating surgeon performance and discusses current strategies to enhance transparency on surgical care quality, such as the National Surgical Quality Improvement Program, the Surgeon Scorecard, and private assessment initiatives.
McAlister C. N Engl J Med. 2015;372:2477-9.
Training new physicians can introduce potential for error, and there is concern that transparency around trainee involvement in providing care can limit educational opportunities. Describing a case involving a trainee who performed cataract surgery without disclosing this information to the patient, this commentary explores the need to openly discuss trainee participation in procedures and how such transparency can lead to enhanced tracking of surgical outcomes.
Szekendi MK, Barnard C, Creamer J, et al. Jt Comm J Qual Patient Saf. 2010;36:3-9.
Morbidity and Mortality (M&M) conferences are a time-honored part of medical training. However, these conferences are only rarely used to discuss medical errors or patient safety problems. Even when errors are discussed, learning opportunities may be limited due to lack of a formal mechanism for analysis and follow-up. This article discusses how one academic hospital restructured their monthly M&M conference to focus specifically on patient safety and quality improvement learning objectives. Cases were selected based on voluntary error reports and were presented in a root cause analysis format in an interdisciplinary fashion. Implementation of the restructured conference was associated with improvement in safety culture perception (as measured by the AHRQ Hospital Survey on Patient Safety Culture), and the nursing and pharmacy departments subsequently implemented similar conferences.