Misinterpretations of critical tests can lead to diagnostic delays and patient harm. This review suggests combining computerized and human analysis of electrocardiogram results to enhance test interpretation accuracy and effectiveness.
Basner M; Asch DA; Shea JA; Bellini LM; Carlin M; Ecker AJ; Malone SK; Desai SV; Sternberg AL; Tonascia J; Shade DM; Katz JT; Bates DW; Even‑Shoshan O; Silber JH; Small DS; Volpp KG; Mott CG; Coats S; Mollicone DJ; Dinges DF; iCOMPARE Research Group.
This cluster-randomized trial compared an internal medicine residency schedule that adhered to 2011 duty hour regulations to a flexible schedule that maintained an overall 80-hour work week. Self-reported sleepiness and measured sleep duration did not differ by group, but residents in the flexible programs performed worse on psychomotor vigilance testing, a measure of alertness. The authors recommend implementing fatigue-management training during residency.
Artificial intelligence (AI) technologies can improve the use of data in care delivery. This review recommends steps to enhance the use of AI in bedside care. The author highlights the need for clinicians to accept that AI tools will affect care processes and be trained to participate in AI integration on the front line.
Sun E, Mello MM, Rishel CA, et al. JAMA. 2019;321:762-772.
Scheduling overlapping surgeries has raised substantial patient safety concerns. However, research regarding the impact of concurrent surgery on patient outcomes has produced conflicting results. In this multicenter retrospective cohort study, researchers examined the relationship between overlapping surgery and mortality, postoperative complications, and surgery duration for 66,430 surgeries between January 2010 and May 2018. Although overlapping surgery was not significantly associated with an increase in mortality or complications overall, researchers did find a significant association between overlapping surgery and increased length of surgery. An accompanying editorial discusses the role of overlapping surgery in promoting the autonomy of those in surgical training and suggests that further research is needed to settle the debate regarding the impact of overlapping surgery on patient safety.
Ratwani RM, Reider J, Singh H. JAMA. 2019;321:743-744.
Health information technology (IT) usability problems can affect patient safety. This commentary offers strategies to reduce the potential for unintended consequences associated with health IT. Recommendations include instituting a national registry of usability issues, establishing design standards, addressing unintended harms, simplifying documentation requirements, and developing standard measures for usability and safety.
Jones TS, Black IH, Robinson TN, et al. Anesthesiology. 2019;130:492-501.
Surgical fires, though uncommon, can result in serious harm. This review highlights three components to be managed in the operating room to prevent fires: an oxidizer, an ignition source, and a fuel. The authors provide recommendations to ensure each element is handled safely.
Carayon P, Wooldridge A, Hose B-Z, et al. Health Aff (Millwood). 2018;37:1862-1869.
System and process weaknesses can hinder safe patient care. This commentary raises awareness of human factors engineering as a key opportunity for enhancing patient safety. The authors provide recommendations to drive adoption and spread of human factors strategies through targeted education, clinician–engineer partnerships, and coordinated improvement efforts.
Scott IA, Pillans PI, Barras M, et al. Ther Adv Drug Saf. 2018;9:559-573.
The prescribing of potentially inappropriate medications is a quality and safety concern. This narrative review found that information technologies equipped with decision support tools were modestly effective in reducing inappropriate prescribing of medications, more so in the hospital than the ambulatory environment.
Bajaj K, Minors A, Walker K, et al. Simul Healthc. 2018;13:221-224.
Frontline simulations offer valuable opportunities to explore system issues, process weaknesses, and teamwork skills. This article discusses risks associated with in situ simulations and describes how to determine when simulations should be canceled, postponed, or relocated to ensure safety.
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