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- Error Reporting and Analysis 8
- Human Factors Engineering 1
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- Quality Improvement Strategies 4
- Technologic Approaches 3
- Device-related Complications 1
- Diagnostic Errors 6
- Discontinuities, Gaps, and Hand-Off Problems 1
- Fatigue and Sleep Deprivation 2
- Medical Complications 8
- Medication Errors/Preventable Adverse Drug Events 7
- Overtreatment 1
- Psychological and Social Complications 1
- Surgical Complications 3
- Family Members and Caregivers 1
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Health Care Providers
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Non-Health Care Professionals
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Search results for ""
Journal Article > Commentary
Mazer BL, Nabhan C. J Gen Intern Med. 2019 Jul 10; [Epub ahead of print].
Web Resource > Multi-use Website
ProPublica, Inc. New York, NY.
Ghaferi AA, Myers C, Sutcliffe KM, Pronovost PJ. Harv Bus Rev. July/August 2016;94.
Achieving high reliability is a recognized goal for health care organizations. Reviewing current technical and standardization enhancements to augment quality and safety in surgery, this article explores how implementing high reliability concepts could further improve safety in surgical care over time.
Rau J. National Public Radio. July 27, 2016.
Although quality rating systems have yet to receive approval across the health care industry, they still serve as a way for consumers to select hospitals and providers. The developers of rating services continue to refine metrics to hone their effectiveness. This news article reports on the latest set of ratings from the Hospital Compare program and concerns associated with the results.
Frakt A. New York Times. July 11, 2016.
Patients are increasingly using online symptom checkers for medical information and health care recommendations. This newspaper article reports on various health information applications that provide triage advice to patients and points out that physicians have significantly lower rates of diagnostic errors.
Miller N. The Pathologist. June 2016(20):18-29; July 2016(21):18-33.
In light of the growing focus on diagnostic errors, this magazine series reports on unique challenges that pathologists face when they discover potential errors. The first article in the series discusses how pathologists may experience barriers to disclosure including feeling shame in disclosing their own error, discomfort with raising concerns about a colleague who has misdiagnosed a patient, and lack of direct relationships with patients. The second article expands the discussion to focus on how industry support of open transparency can enable pathologists to participate in reporting and disclosure activities.
Rau J. Washington Post. May 17, 2016.
Collecting data to meet quality measurement requirements adds to resource burden for many health care organizations, and there is controversy around the benefits of such rating systems for both patients and clinicians. This news article discusses problems with the Centers for Medicare and Medicaid Services rating mechanism, Hospital Compare.
Landro L. Wall Street Journal. May 9, 2016.
Closed claims have been considered a source for adverse event data for years, and recently such data has been utilized to inform safety improvement work. This newspaper article reviews several organizational efforts that use claims data to determine factors that contribute to failure and strategies to address them, including process redesign and enhanced patient education.
Rau J. Washington Post. April 29, 2016.
Transitions in care between inpatient and outpatient settings are an increasing concern for patient safety. Reporting on a fatal medication error that was missed by a patient's pharmacist and home health nurses, this newspaper article discusses various risks associated with hospital-to-home transitions such as insufficient case management and communication.
Journal Article > Study
Lagu T, Goff SL, Craft B, et al. J Hosp Med. 2016;11:52-55.
Researchers in this study reviewed patient feedback posted on a hospital's Facebook page to determine whether social media may be a helpful mechanism for identifying patient safety and quality improvement issues. In this small sample of 37 respondents over a 3-week period, insights from social media comments did not seem to add much to the feedback already collected by more traditional methods, such as patient satisfaction surveys.
Journal Article > Review
Systematic review on the prevalence, frequency and comparative value of adverse events data in social media.
Golder S, Norman G, Loke YK. Br J Clin Pharmacol. 2015;80:878-888.
Medication errors are common in the outpatient setting and frequently lead to emergency department visits and hospital admissions. The growth in social media use potentially provides a way to identify safety hazards quickly. This systematic review sought to examine whether social media could provide unique insights into safety issues compared to standard methods of detecting safety hazards. The included studies searched a variety of social media sites (e.g., Twitter, YouTube, and discussion forums) and found that a large number of adverse events are discussed in real time. Most of these events tended to be mild, such as symptoms or asymptomatic lab test abnormalities. Serious adverse events, those requiring urgent treatment or hospitalization, were relatively underrepresented. Although searching social media may help identify unique safety hazards, the investigators concluded that current evidence is insufficient to determine whether routine analysis of social media is of added benefit to traditional surveillance methods.
Jaffe I, Renincasa R. Morning Edition. National Public Radio. December 8–9, 2014.
Overprescribing of medications is a common problem in nursing homes. This two-part radio segment reports on the inappropriate use of antipsychotic medications as a chemical restraint for patients with dementia. The first part introduces the issue and includes insights from families that have experienced harm due to the practice. The second segment discusses programs that the Centers for Medicare and Medicaid Services has put in place to address the problem through a more patient-centered approach to care and suggests strengthening penalties against organizations that overuse antipsychotics.
Stock S, Putnam J, Carroll J, Pham S. NBC Bay Area. November 19, 2014.
Hospital reporting of errors in the United States has been suboptimal. This news video investigates the effectiveness of a state reporting initiative in California. Although hospitals have reported 6282 adverse events to the state in 4 years, patient safety experts suggest that those results do not reliably represent all the incidents that should have been submitted.
Goldman B. "White Coat, Black Art." CBC Radio. October 31, 2014.
This radio segment explores whether sleep deprivation affects the safety of care delivery. Panelists discuss sleep deprivation in health care, the influence of hierarchy and peer behaviors in normalizing fatigue, and the impacts of duty hour limits on patient safety. This contributes to the continuing debate about the benefits of work hour reductions and its potential to detract from residents' competency.
Webster H. US News & World Report. October 27, 2014.
This magazine article explores whether receiving care at a teaching hospital affects patient safety and highlights how the demands of the educational process can actually augment safety, as attendings at these institutions typically remain up-to-date on new evidence to respond to students' questions and supervision is required for students performing procedures.
Ryan J. All Things Considered. National Public Radio. October 16, 2013.
This radio news segment reports on patient falls, including risk factors and prevention strategies.
Rodricks D. Baltimore Sun. October 14, 2014.
Although significant progress has been made in improving patient safety over the past decade, many medical errors continue to occur. In light of the recent incident involving transmission of the Ebola virus from a patient to a nurse at a Dallas hospital, this newspaper article reports on how lapses in following standard procedures in care environments, such as insufficient handwashing, can result in preventable harm.
Beck M. Wall Street Journal. September 14, 2014.
Overdiagnosis has emerged as a patient safety issue. Reporting on how the push for early identification of cancer has led to screening, detection, and treatment of tumors that may never cause harm, this newspaper article discusses the impact of unnecessary tests and treatment on patients and health systems. Researchers are working to design better tests to distinguish between benign abnormalities and cancers.
Hartocollis A, Goodman JD. New York Times. September 9, 2014.
Office-based anesthesia is becoming more common despite concerns regarding its safety. This newspaper article reports on factors to enhance safety of surgical care in ambulatory settings, such as adequate screening of patient risks, availability of staff trained to perform intubations when needed, and ensuring access to lifesaving equipment as strategies.
O'Donnell J. USA Today. September 7, 2014.