Clinician workload has been linked with poor patient outcomes. This retrospective cohort study assessed the outcomes for patients undergoing coronary artery bypass graft (CABG) performed as a surgeons’ first versus non-first procedure of the day. Findings suggest that prior workload adversely affected outcomes for patients undergoing CABG surgery, with increases in adverse events, myocardial infarction, and stroke compared to first procedures.

The COVID-19 pandemic has presented numerous challenges for the healthcare workforce, including redeploying personnel to different locations or retraining personnel for different tasks. Researchers interviewed hospital leaders from health systems in the United States, United Kingdom, New Zealand, Singapore and South Korea about redeployment of health care workers during the COVID-19 pandemic. The authors discuss effective practices and lessons learned preparing for and executing workforce redeployment, as well as concerns regarding redeployed personnel

The COVID-19 pandemic has resulted in concerns about psychological and emotional well-being of health care professionals. In this cross-sectional study, critical care and emergency nurses in Spain report fears of COVID-19 infection, elevated workloads, higher nurse-to-patient ratios, communication struggles with management, and socio-emotional challenges in caring for their patients and themselves during the pandemic.

This systematic review of interventions to increase employee well-being in health care settings identified multiple strategies. Individual-level strategies included physical health promotion, stress management interventions, and complementary and alternative medicine. System-level approaches included changing work practices and implementing multicomponent interventions. Lack of consistent measures and robust evaluation strategy impeded assessment of which strategies were most effective.

Missed nursing care may result from inadequate nurse staffing and explain the relationship between nurse-to-patient ratios and patient outcomes. Research has shown that higher nurse staffing levels are associated with lower inpatient mortality and that reduced staffing increases the risk for postoperative complications. In this study, investigators examined data from more than 400,000 surgical patients from 300 hospitals in 9 countries as well as survey responses from 26,516 nurses. They found a significant association between nurse staffing and missed nursing care with 30-day risk-adjusted postoperative mortality. The authors conclude that measuring missed nursing care may help identify patients at greater risk for adverse outcomes earlier in their course. A past WebM&M commentary highlighted important issues associated with nurse staffing ratios.

This study used a previously validated instrument to quantify the frequency with which hospital-based doctors were interrupted in the course of their clinical activities and the effect on overall workload. The investigators found that interruptions were common and associated with higher perceived workload.

The sterile cockpit rule mandates elimination of nonessential activities during aircraft takeoffs and landings. This study found disturbingly frequent interruptions during analogous phases of anesthesia management, demonstrating the need to develop a similar rule for the operating room.

More than one-third of Swiss surgeons in this survey met criteria for burnout. Burnout has been linked to medical errors in prior studies.

Classic research has demonstrated a link between increased surgical volume and improved patient outcomes at the hospital level. This research has raised interest in systematic referral of certain procedures to specialized centers, and the Leapfrog Group included volume-based referral as one of its recommended safety practices. However, this study finds that the volume–outcome relationship is limited to a few specific surgeries, and that wide overall variation in surgical mortality exists even after controlling for volume. The authors argue that given these findings, systematic volume-based referral is unlikely to improve surgical outcomes.

In this survey, residency program directors and residents indicated that new regulations limiting duty hours for surgical residents to 50 hours per week have had a negative impact on residents' educational experience.

Safety improvement efforts are often guided by error data that are gathered retrospectively (e.g., incident reports). This study reports on a collaborative process used to prospectively identify safety hazards and improvement strategies in perioperative care.

Increased nurse staffing on postoperative general wards—but not in the intensive care unit—was associated with reduced mortality for cardiac surgery patients.

This Finnish study found that both longer work hours and poor teamwork were associated with an increased risk of health care–associated infections.

This article reviews factors contributing to anesthesia-related cardiac arrests and details prevention strategies.