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Journal Article > Study
Older patients' understanding of emergency department discharge information and its relationship with adverse outcomes.
Hastings SN, Barrett A, Weinberger M, et al. J Patient Saf. 2011;7:19-25.
This study of geriatric patients discharged from a teaching hospital emergency department (ED) found that nearly 20% did not understand either their diagnosis or how to care for themselves at home, and the majority did not know the expected course of their illness or when to return to the ED. The study corroborates prior research showing that many ED patients do not comprehend their discharge instructions, and that a large proportion of hospitalized patients are unaware of their diagnosis. Many factors may play a role in this discrepancy, including low health literacy and suboptimal patient–provider communication. An AHRQ WebM&M perspective discusses the broader issue of patient safety in the emergency department.
Journal Article > Review
Systematic review of safety checklists for use by medical care teams in acute hospital settings—limited evidence of effectiveness.
Ko HCH, Turner TJ, Finnigan MA. BMC Health Serv Res. 2011;11:211.
Checklists have resulted in some of the most prominent successes of the patient safety movement, and the resulting publicity has led to wider implementation of checklists in a variety of care settings. This rapid dissemination of checklists has been accompanied by cautionary notes from those who have examined successful checklist-based interventions, who stress the importance of safety culture and other factors in ensuring intervention success. This systematic review of nine published studies of checklists also strikes a cautionary note, finding only moderate evidence that checklists are associated with safety improvements and noting significant methodological weaknesses in the existing literature base. Checklists are a powerful improvement tool, but as this study highlights, their success is often dependent on other interventions.
Journal Article > Commentary
Schiff GD, Martin SA, Eidelman DH, et al. Ann Intern Med. 2018;169:643-645.
Safe diagnosis is a complex challenge that requires multidisciplinary approaches to achieve lasting improvement. The authors worked with a multidisciplinary panel to build a 10-element framework outlining steps that support conservative diagnosis. Recommendation highlights include a renewed focus on history-taking and physician examination, as discussed in a PSNet perspective. They also emphasize the importance of continuity between clinicians and patients to build trust and foster timely diagnosis. Taken together with recommendations for enhanced communication between specialist and generalist clinicians and more judicious use of diagnostic testing, this report is a comprehensive approach to reducing overdiagnosis and overtreatment.
Journal Article > Study
"Closing the loop": a mixed-methods study about resident learning from outcome feedback after patient handoffs.
Shenvi EC, Feupe SF, Yang H, El-Kareh R. Diagnosis (Berl). 2018;5:235-242.
Seeking feedback on patient outcomes after a patient handoff takes place may provide useful learning for the provider who initially cared for the patient and inform future clinical decision-making. In this mixed-methods study, residents identified both a lack of time and inadequate systems for tracking patients as significant barriers to learning from the outcomes of patients they had handed over to other teams.