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The infectious nature of COVID continues to impact the safety of hospitalized patients. This article series examines factors contributing to hospital-acquired COVID-19 infection that include weaknesses in oversight, patient legal protections, and documentation.

Implicit biases are rooted in culture and context. This special issue examines a broad range of influences and impacts of medical harm enabled by societal acceptance of inequalities both within medicine and beyond it.

This monthly commentary explores a wide range of subjects associated with patient safety, such as infection prevention, surgical quality improvement, and high reliability organizations.

COVID-19 is a novel coronavirus that harbors a variety of diagnostic, treatment, and management hurdles. This special issue covers a variety of clinical topics including optimal diagnostic methods, near misses, and diagnostic accuracy.   

In this continuing series, high-performance work practices are explored and defined through literature review, case analysis, and research. The authors summarize findings and discuss how best practices can influence quality, safety, and efficiency outcomes. Topics covered include speaking up, central line infection prevention, and business case development.

Simulation is a recognized technique to educate and plan to improve care processes and safety. This pair of special issues highlights the use of simulation in nursing and its value in work such as communication enhancement, minority population care, and patient deterioration.   

The COVID-19 crisis has disproportionally impacted the lives of older adults, their caregivers, and the communities in which they live. This special issue includes articles examining topics such as the role of policies affecting this patient population, effective communication with older adults and concerns associated with long-term care facilities.    

The Eisenberg Awards honor individuals and organizations who have had noteworthy impacts on patient safety and quality improvement. This article collection highlights the work of the 2019 honorees: Gordon D. Schiff, MD; WellSpan Health, York, Pennsylvania; and HCA Healthcare, Nashville, Tennessee.

Articles in this special issue report on initiatives undertaken by the Canadian National Patient Safety Consortium with a focus on the effect patient partnerships on initiative priority areas including never events, safety culture and homecare safety improvements.

The neonatal intensive care unit (NICU) is a complex environment that serves a vulnerable population at increased risk for harm should errors occur. This special issue draws from a multidisciplinary set of authors to explore patient safety issues arising in the NICU. Included in the issue are articles examining topic such as video assessment, diagnostic error, and human factors engineering in the NICU.

The States Targeting Reduction in Infections via Engagement (STRIVE) initiative was 3-year hospital-based program using a multimodal, evidence-based intervention targeted at reducing healthcare-associated infections (HAI) and strengthening state-hospital relationships to improve infection control efforts. The intervention recruited hospitals with a high burden of HAI; a total of 337 hospitals across 23 states and the District of Columbia participated in the program. The STRIVE intervention consistent of four components: (1) baseline assessment of each participating hospital conducted by a state partner, (2) tiered approach to HAI prevention, (3) educational content, and (4) on-site technical assistance. PubMed citations Central-line Associated Blood Stream Infection (CLABSI) Over the three-year study period, no substantial reduction in CLABSI rates were observed; unadjusted rates decreased from 0.88 to 0.80 infections per 1,000 catheter-days. The authors did observe reductions in central-line catheter use during the study period (24.05 to 22.07 central line-days per 100 patient-days); however, this trend was also documented in the pre-intervention period. Catheter-Associated Urinary Tract Infection (CAUTI) Baseline CAUTI rates at participating hospitals were low. Over the three-year study period, the unadjusted CAUTI rate decreased slightly; unadjusted rates decreased from 1.12 to 1.04 infections per 1,000 catheter-days. Unadjusted urinary catheter use decreased from 21.46 to 19.83 catheter-days per 100 patient-days. Clostridioides Difficile Infection (CDI) The authors observed a statistically significant reduction in Clostridioides difficile infection (CDI) over the three-year period, from 7.0 cases days to 5.7 cases per 10,000 patient-days. However, these decreases mirrored national trends in CDI reduction and are likely attributed to recent emphasis on CDI clinical guidelines, mandated CDI reporting, and the inclusion in value-based purchasing, rather than the STRIVE intervention. Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection. Baseline MRSA rates at participating hospitals were low. Over the three-year period, the unadjusted MRSA rate decreased slightly from 0.075 to 0.071 cases per 1,000 patient-days. State Partner Relationships and HAI Prevention Efforts While STRIVE did not result in quantitative improvements in CAUDI, CLABSI, CDI or MRSA rates, the initiative did strengthen relationships between hospitals and state health departments. Through the baseline assessment, state partners were able to identify gaps in HAI prevention efforts and opportunities to improve partner-hospital relationships. State partners also reported improvements in hospital-level prevention activities over the three-year period, as well as improvements to state partner-hospital relationships.

Patient safety has been described as an unmet need in physician training. This special issue covers areas of focus for a patient safety curriculum drawn from experience in the German medical education system. Topics covered include human error, blame, and responsibility. Articles also review the epidemiology of common problems such as medication safety, organizational contributors to failure, and diagnostic error.

Nursing home patients are vulnerable to preventable harm due to poor safety culture, insufficient staffing levels, lack of regulation enforcement, and misaligned financial incentives. This news investigation reports on how poor practices resulted in resident harm in Pennsylvania nursing homes and discusses strategies for improvement, such as enhancing investigation processes.

The Institute of Medicine report, To Err Is Human, marked the founding of the patient safety field. This special issue of Health Affairs, published 20 years after that report, highlights achievements and progress to date. One implementation study of evidence-based surgical safety checklists demonstrated that leadership involvement, intensive activities, and engagement of frontline staff are all critical to successful adoption of safety practices. Another study demonstrated that communication-and-resolution programs either decreased or did not affect malpractice costs, providing further support for implementing such programs. Experts describe the critical role of human factors engineering in patient safety and outline how to enhance the use of these methods. The concluding editorial by David Bates and Hardeep Singh points to progress in reducing hospital-acquired infections and improving medication safety in acute care settings and highlights remaining gaps in the areas of outpatient care, diagnostic errors, and electronic health record safety. In the related information, the Moore Foundation provides free access to five articles in this special issue.

Iatrogenesis—an adverse effect of medical care—is an area of focus in patient safety. Articles in this special issue explore cases involving iatrogenic harm in pediatric care as learning opportunities for pediatricians. Topics covered include psychological harm following a neonatal intensive care unit stay and the etiology of iatrogenesis in pediatrics.

Articles in this special issue provide insights into how human error can affect the safety of oral and maxillofacial surgery, a primarily ambulatory environment. The authors cover topics such as simulation training, wrong-site surgery, and the safety of office-based anesthesia.

The Eisenberg Award honors individuals and organizations who have made vital accomplishments in improving quality and patient safety. This special collection of articles provides insights on the work of the 2015 honorees: Pascale Carayon, PhD; Premier, Inc.; and Mayo Clinic Hospital-Rochester.

Safety challenges in residential care facilities are well documented. Articles in this special issue explore falls in rehabilitation settings, including nurses' role in managing fall risks and strategies to prevent falls.