Health literacy is a social determinant of health and can affect the ways people understand and interact with the health system. This review describes categories of health literacy, how it functions as a social determinant of health, and interventions to improve health literacy at system, community, and individual levels.

This systematic review of 54 studies found that over half of adult and pediatric patients experienced a medication error post-discharge, and that these errors regularly involved common drug classes such as antibiotics, antidiabetics, analgesics, and cardiovascular drugs. The authors suggest that future research examine the burden of post-discharge medication errors, particularly in pediatric populations.

Physicians commonly use diagnostic algorithms and practice guidelines to individualize risk assessment and guide clinical decisions. The authors discuss the possible dangers of using race-adjusted algorithms due to their potential to lead to diagnostic errors and delays in care.

This article discusses the impact of the lack of healthcare worker support on resilience, patient safety, and staff retention during the COVID-19 pandemic and provides recommendations for better supporting psychological safety among healthcare workers. 

This commentary discusses the ongoing impact of COVID-19 on the physical, emotional, and mental health on the healthcare workforce and outlines five high-priority actions at the organizational- and national level to protect the health and wellbeing of the healthcare workforce during and after the pandemic.  

This Cochrane review evaluated the differential impacts of personal protective equipment (PPE) types and methods of donning/doffing on contamination and infection risk for healthcare workers. The authors included 24 studies (14 randomized controlled trials) representing over 2,200 patients. The authors found that PPE covering more body surface area may lead to better protection but at the cost of more difficult donning or doffing – for example, a powered, air-purifier respirator may protect against contamination better than a N95 mask and gown but with less compliance with donning. PPE design modifications may decrease the risk of contamination compared to standard PPE (e.g. better fit around neck, wrists and hands). Certain donning and doffing procedures, such as following CDC doffing guidance, may reduce contamination and increase compliance. The authors note that simulation studies exploring which combinations of PPE and specific donning/doffing procedures protect best against contamination are warranted.

Using clinical artificial intelligence as an example, these authors posit that digital tools are challenging standard clinical practices around assigning blame and assuring patient safety. They discuss moral accountability for harm to patients and safety assurances to protect patients against such harm, and examine these issues from both a clinician and patient perspective.

This meta-analysis examined the psychological effects of viral outbreaks on clinicians and effective strategies to manage stress and psychological distress. The review included 59 studies involving severe acute respiratory syndrome (SARS), COVID-19, Middle East respiratory syndrome (MERS), Ebola and influence. Compared with clinicians at lower risk, those in contact with affected patients had greater levels of both acute and post-traumatic stress, as well as psychological distress. Clinicians were at increased risk for psychological distress if they were younger, more junior, had dependent children, or had an infected family member. Identified interventions to mitigate stress and psychological distress included clear communication, infectious disease training and education, enforcement of infection control procedures, adequate supply of personal protective equipment (PPE) and access to psychological support.

This systematic review analyzed 36 articles exploring factors enabling psychological safety in healthcare teams. The review identified five themes of enabling factors: (1) priority for patient safety, such as safety culture or leadership behavior; (2) improvement or learning orientation leading to a culture of continuous improvement or change-oriented leadership; (3) support from peers, leadership or the organization; (4) familiarity between and across teams and with team leaders, and; (5) status, hierarchy and inclusivity. These themes can aid future objective measures of psychological safety and interventions to improve psychological safety within teams. 

This systematic review assessed randomized and non-randomized trials comparing the performance of artificial intelligence (AI; specifically deep learning algorithms) in medical imaging versus expert clinicians in order to characterize the state of the evidence and suggest future research directions which encourage innovation while protecting patients. The review identified 10 registered trials and 81 published non-randomized trials. Although 61 of 81 published studies reported that AI performance was comparable or better than that of clinicians, the authors identified few prospective studies or studies conducted in real-world settings; additionally, overall risk of bias was high and adherence to reporting standards was poor. Future studies examining the impact of AI in medicine must decrease risk of bias, increase relevance to real world clinical settings, and improve reporting and transparency.

To support the needs of healthcare workers during the COVID-19 pandemic, this rapid evidence review of qualitative research studies sought to identify barriers and facilitators to healthcare workers adherence to infection prevention and control guidelines for respiratory infectious diseases. The authors included 20 studies in their analysis; these studies explored the views and experiences of nurses, doctors and other healthcare workers working in hospitals, primary care, and community care settings dealing with infectious diseases such as SARS, H1N1, MERS, TB, or seasonal influenza. Identified barriers included local guidelines that were lengthy, ambiguous or not reflective of national or international continuously changing guidelines, lack of support from management to adhere to guidelines, and lack of high-quality personal protective equipment (PPE). Facilitators to guideline adherence included clear communication and training about the infection and use of PPE, sufficient space to isolate patients, workplace safety culture, and perceived value of adhering to infection prevention and control guidelines.

The authors describe eight empirical recommendations for optimizing infection control and operating room (OR) management during the COVID-19 pandemic. Recommendations address (1) hand hygiene, (2) environmental cleaning, (3) patient decolonization, (4) vascular care, (5) surveillance of pathogen transmission, (6) efficient use of personal protective equipment (7) OR scheduling, and (8) postoperative recovery settings.

To address the negative psychological impacts faced by healthcare workers during the COVID-19 crisis, the authors of this commentary recommend three strategic principles for healthcare institutions responding to the pandemic: Encourage leadership to focus on resilience  Ensure that crisis communication provides both information and empowerment Create a continuum of staff support within the organization to address a surge in mental health concerns among healthcare workers.

This systematic review is an update of prior research characterizing the evidence base on team effectiveness in healthcare organizations. The review analyzed 297 publications focused on three types of interventions: (1) training, including crew resource management, TeamSTEPPS and simulations, (2) tools, including SBARs and checklists, and (3) organizational (re)designs, which involves intervening in structures which lead to improved team functioning (such as changing the physical environment or altering roles/responsibilities). The authors found that existing evidence base is limited to certain interventions, settings (primarily acute care), and outcomes (primarily non-technical skills). The authors call for more longitudinal research, particularly examining team functioning outside the hospital setting.

Prior research has found poor communication between hospital-based and primary care physicians and has suggested that this may contribute to medical errors. This systematic review included 19 studies assessing the transfer of information at hospital discharge between hospital-based and primary care providers (PCPs), or evaluating interventions aimed at improving the timeliness and quality of discharge information. The review found that timely communication of discharge summaries was low, with 55% (median) transferred to PCPs within 48 hours and 85% (median) within 4-weeks; 8.5% of discharge summaries were never transferred. Discharge summaries nearly always contained patient demographics, admission/discharge dates and primary diagnoses, but less frequently included pending test results, diagnostic tests performed and discharge medications.

Organizational cultures that encourage psychological safety has been shown to increase safe healthcare practices. This systematic review evaluated fourteen studies targeting psychological safety, speaking up and voice behavior within healthcare settings; studies primarily used educational interventions including simulation (5 studies), video presentations (2 studies), case studies (3 studies) or workshops (1 study). While some interventions showed improvement in psychological safety, this was not consistently demonstrated across studies. The authors note that the ability to demonstrate improvements were limited by lack of objective outcome measures and the inability of educational interventions alone to result in behavior change. 

In this systematic review, the authors synthesized evidence on polypharmacy in older adults and subsequent adverse health outcomes, as well as impacts on social outcomes (e.g., loneliness), medication management (e.g., nonadherence) and healthcare utilization. Results from twenty-six reviews encompassing 230 unique studies showed that polypharmacy is associated with increased hospitalizations and inappropriate prescribing. The authors describe conflicting evidence on associating polypharmacy with adverse outcomes, including adverse drug events and disability. Evidence on the adverse social outcomes, as well as harms in adults 85 years and older, was limited.