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Search results for "United States of America"

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Journal Article > Study

Workplace factors associated with burnout of family physicians.

Rassolian M, Peterson LE, Fang B, et al. JAMA Intern Med. 2017 May 8; [Epub ahead of print].

Professional burnout is a pervasive problem among health care workers that can have serious effects on patient safety. This survey of family medicine physicians found that a chaotic work environment and the time burden related to electronic health record documentation were both associated with burnout. These results underscore the need to address workplace conditions that contribute to burnout in primary care.

Journal Article > Commentary

Identifying and analyzing diagnostic paths: a new approach for studying diagnostic practices.

Rao G, Epner P, Bauer V, Solomonides A, Newman-Toker DE. Diagnosis. 2017;4:67-72.

This commentary explores diagnosis of common conditions in primary care and highlights approaches for studying the process, such as practice variation and patterning. The authors suggest big data as a method to mine electronic medical records to identify the information needed to inform improvement.

Book/Report

Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families.

Rockville, MD: Agency for Healthcare Research and Quality; April 2017.

Patient engagement in the process of care is important to improve safety in primary care. This guide includes case studies and highlights handoffs, teach-back, tools to prepare patients for appointments, and brown-bag medication management as strategies to encourage patients and caregivers to participate in safety.

Journal Article > Study

Primary care collaboration to improve diagnosis and screening for colorectal cancer.

Schiff GD, Bearden T, Hunt LS, et al. Jt Comm J Qual Patient Saf. 2017;43:338–350.

Delayed diagnosis of colon cancer due to missed screening or follow-up leads to preventable morbidity and mortality. In this quality improvement effort, the study team sought to enhance colon cancer screening in primary care. They identified several important drivers of successful screening programs, including leadership support, patient engagement, teamwork, tracking of results, closed loops for referrals, and health information technology tools to support best practices. Sequential plan-do-study-act cycles were implemented to improve processes. Participating practices had widely varying baseline screening rates, and some sites demonstrated significant improvements from baseline while others did not change. The effort required to augment colon cancer screening in primary care demonstrates the challenge of implementing evidence-based practices in order to achieve timely diagnosis of cancer.

Book/Report

Patient Safety: Investigating and Reporting Serious Clinical Incidents.

Kelsey R. CRC Press: Boca Raton, FL; 2017. ISBN: 9781498781169.

Research is increasingly focusing on patient safety in primary care. This book discusses the importance of detecting and assessing mistakes that result in patient harm and describes how to conduct a root cause analysis to investigate clinical incidents in the primary care setting.

Journal Article > Study

Improving communication with primary care physicians at the time of hospital discharge.

Destino LA, Dixit A, Pantaleoni JL, et al. Jt Comm J Qual Patient Saf. 2017;43:80-88.

Adverse events after hospital discharge are common. Prior research demonstrates that communication and information transfer between inpatient providers and primary care physicians (PCPs) may be lacking, raising patient safety concerns. This study described how applying Lean methodology, enhancing frontline provider engagement, and redesigning workflow processes within the electronic health record led to improved communication with PCPs around the time of hospital discharge. Through these interventions, the pediatric medical service was able to increase verbal communication with PCPs at discharge to 80%, and they sustained this for a 7-month period. Discharge communication with PCPs across other services improved as well. A previous PSNet perspective discussed the challenges associated with care transitions and suggested opportunities for improvement.

Journal Article > Study

Screening for medication errors using an outlier detection system.

Schiff GD, Volk LA, Volodarskaya M, et al. J Am Med Inform Assoc. 2017;24:281-287.

Medication errors continue to occur despite implementation of computerized provider order entry and clinical decision support systems. This study sought to assess whether medication error alerts might have a greater impact on mitigating such errors if they were generated based on outlier detection screening. Researchers analyzed data from the electronic health records of 747,985 outpatients to identify outliers that might indicate a medication error. They then chose 300 charts from the 15,693 resulting alerts. The charts were reviewed using a coding system to evaluate the utility of the alerts generated. About 75% of the chart-reviewed alerts created by the screening system identified possible medication errors. The authors suggest that using this type of outlier detection screening to generate alerts might improve existing clinical decision support systems' ability to mitigate medication errors. A prior WebM&M commentary discussed an incident involving an electronic prescribing error.

Journal Article > Study

Delayed workup of rectal bleeding in adult primary care: examining process-of-care failures.

  • Classic

Weingart SN, Stoffel EM, Chung DC, et al. Jt Comm J Qual Patient Saf. 2017;43:32-40.

Delayed cancer diagnosis is a critical patient safety concern in primary care. Rectal bleeding is an important issue to recognize promptly, because it may be a symptom of colon cancer, for which delayed diagnosis can lead to worse outcomes. For this retrospective study, physician reviewers examined 438 abstracted medical records of patients with rectal bleeding to identify problems in the diagnostic process. In the majority of cases, they identified problems such as failure to elicit sufficient family history, incomplete physical examination performance or documentation, and lack of needed laboratory testing. Consistent with prior studies, failure to order laboratory testing and plan follow-up were associated with worse care quality. These findings emphasize the challenges of achieving timely and accurate diagnosis in the outpatient setting. In a related editorial, Hardeep Singh suggests that enhancing electronic health record capability and trigger tools could address diagnostic delays in primary care.

Journal Article > Commentary

Addressing ambulatory safety and malpractice: the Massachusetts PROMISES project.

Schiff GD, Reyes Nieva H, Griswold P, et al. Health Serv Res. 2016;51(suppl 3):2634-2641.

Prior research has shown that malpractice risk in the outpatient setting is significant and that claims frequently involve missed and delayed diagnoses. This editorial describes lessons learned from the Massachusetts PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) project. Funded by the Agency for Healthcare Research and Quality, the PROMISES project involved a multipronged intervention within 16 randomly selected primary care practices to address known areas of risk in ambulatory care, including test result management, referrals, medication management, and communication issues. A previous PSNet perspective discussed how research may help improve the malpractice system.

Journal Article > Commentary

National Action Plan for Adverse Drug Event Prevention: recommendations for safer outpatient opioid use.

Ducoffe AR, York A, Hu DJ, Perfetto D, Kerns RD. Pain Med. 2016;17:2291-2304.

Accidental overuse of opioid medications in the ambulatory environment is a prominent patient safety concern. This commentary reviews a national plan to curb adverse drug events and applies those recommendations to guide efforts to improve opioid safety.

Book/Report

Patient Safety in Ambulatory Settings.

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Shekelle, PG, Sarkar U, Shojania K, et al. Technical Brief No. 27. Rockville, MD: Agency for Healthcare Research and Quality; October 2016. AHRQ Publication No. 16-EHC033-EF.

Most patient safety research and initiatives have focused on the hospital environment, despite the fact that much of health care is delivered in outpatient settings. This technical brief explores gaps in the evidence base that hinder understanding of safety concerns and factors unique to ambulatory care and notes that studies on patient engagement and diagnostic error are lacking.

Journal Article > Commentary

Preventing diagnostic errors in primary care.

Ely JW, Graber ML. Am Fam Physician. 2016;94:426-432.

The Improving Diagnosis in Health Care report advocated for enhancing patient engagement as a strategy to reduce diagnostic error. This commentary suggests that discussing uncertainty, seeking second opinions, and utilizing a checklist to guide decision-making can help engage primary care patients in the diagnostic process.

Journal Article > Study

Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study.

Tudor Car L, Papachristou N, Bull A, et al. BMC Fam Pract. 2016;17:131.

Compared with other patient safety issues, diagnostic errors have received little attention until recently. Missed or delayed diagnoses are a common reason for malpractice claims. This study sought to determine barriers and solutions to delays in diagnosis in primary care. Investigators sent a questionnaire to more than 500 clinicians and received 113 responses. Participants identified 33 discrete problems associated with delays in diagnosis and suggested 27 solutions. The main issues included inability to meet patients' care needs and inadequate communication between secondary and primary care. The top solutions included improving training of primary care doctors and enhancing communication among providers as well as between providers and patients, especially around test results. An Annual Perspective discussed diagnostic errors in more detail.

Journal Article > Study

Do work condition interventions affect quality and errors in primary care? Results from the Healthy Work Place Study.

Linzer M, Poplau S, Brown R, et al. J Gen Intern Med. 2017;32:56-61.

Burnout among clinicians is a widespread patient safety concern. This study compared usual outpatient medical care to an intervention designed to improve clinician working conditions, with the aim of reducing medical errors and enhancing performance on a bundle of care quality measures. The intervention included an assessment of clinician perceptions of working conditions and well-being followed by a locally designed quality improvement project. Each clinic designed an intervention to address the concerns that arose from the assessment. Some clinics chose to work on improving communication or team-based chronic disease management while others focused on redesigning the clinic workflow. Investigators randomized 34 clinics either to receive the intervention or to continue their usual practice and found no differences in medical error rates or care quality measures between the clinics. The authors determined that reducing clinician burnout may not necessarily enhance patient safety and conclude that longer-term, standardized improvement interventions may be needed to augment health care quality.

Book/Report

Report on the Safe Use of Pick Lists in Ambulatory Care Settings.

Rizk S, Oguntebi G, Graber ML, Johnston D. Research Triangle Park, NC: RTI International; 2016.

Standard term selection tools—like pick lists or drop-down menus—in information technology can create opportunities for user error due to human factors. This publication explores how mistakes such as selecting the wrong drug from an ordering pick list can occur in the ambulatory environment. The report includes recommendations and resources to help enhance medication safety when using these tools.

Bibliography

Annotated bibliography: understanding ambulatory care practices in the context of patient safety and quality improvement.

Montano MF, Mehdi H, Nash DB. Am J Med Qual. 2016;31(suppl 2):29S-43S.

The outpatient setting is receiving increased attention as a research focus in patient safety. This bibliography provides an annotated list of articles summarizing safety improvement efforts in the ambulatory setting. Topics explored include safety culture, measurement, team training, test result management, incident reporting, and diagnostic error.

Journal Article > Review

The global burden of diagnostic errors in primary care.

Singh H, Schiff GD, Graber ML, Onakpoya I, Thompson MJ. BMJ Qual Saf. 2017;26:484-494.

The need to improve diagnosis is gaining international recognition. This review summarizes the literature on diagnostic error in primary care and recommends policy and research strategies to prioritize changes needed to enhance diagnostic safety globally.

Journal Article > Study

An acetaminophen icon helps reduce medication decision errors in an experimental setting.

Shiffman S, Cotton H, Jessurun C, Rohay JM, Sembower MA. J Am Pharm Assoc (2003). 2016;56:495-503.

Poor health literacy is associated with the misunderstanding of medication labels, which can lead to adverse drug events. This study sought to assess how adding an acetaminophen icon to the labels of acetaminophen-containing medications affects consumers' ability to avoid unintentional overdose, which is known to cause liver damage. Investigators found that presence of the icon reduced the likelihood of medication errors by 53%, and they concluded that the icon may particularly benefit those with lower health literacy. A past WebM&M commentary discussed a case of liver injury caused by incorrect dosing of acetaminophen.

Journal Article > Study

Communicating findings of delayed diagnostic evaluation to primary care providers.

Meyer AND, Murphy DR, Singh H. J Am Board Fam Med. 2016;29:469-473.

Gaps in follow-up of abnormal test results are known to contribute to delays in diagnosis in primary care, yet primary care practices still lack standard processes to detect and manage abnormal test results. In this study, investigators identified specific abnormal test results requiring follow-up and tested an escalating strategy of communicating with primary care physicians about test results. The study team first sent a secure email with test results to providers, and if the appropriate diagnostic follow-up action did not occur within one week, they made up to three attempts to reach providers by telephone. Email spurred about 11% of providers to act, and more than two-thirds of providers followed up after receiving telephone calls. For the handful of providers who did not act in response to the email or telephone calls, investigators contacted clinic directors. However, even with this patient-specific communication intervention, follow-up of abnormal test results remained incomplete. These results demonstrate that communicating abnormal results to primary care providers is not sufficient to achieve optimal follow-up. As recommended in the Improving Diagnosis report, team-based results management or technological approaches may be needed to assist primary care providers in tracking and following up on outpatient results to promote timely and accurate diagnosis.

Journal Article > Study

Workarounds and test results follow-up in electronic health record–based primary care.

Menon S, Murphy DR, Singh H, Meyer AND, Sittig DF. Appl Clin Inform. 2016;7:543-559.

Implementation of the electronic health record has led to providers engaging in workarounds to circumvent system limitations. This survey found that nearly half of providers at Veterans Affairs medical centers use workarounds when managing test results in the electronic health record. The authors suggest that results management should be improved in future electronic health records and work systems to enhance efficiency and care coordination.

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