Effect of Automated Real-Time Feedback on Early-Sepsis Care: A Pragmatic Clinical Trial.

Objectives: To determine if a real-time monitoring system with automated clinician alerts improves 3-hour sepsis bundle adherence.

Design: Prospective, pragmatic clinical trial. Allocation alternated every 7 days.

What Went Right? A Mixed-Methods Study of Positive Feedback Data in a Hospital-Wide Mortality Review Survey.

Background: Toxic work culture contributes to healthcare worker burnout and attrition, but little is known about how healthcare organizations can systematically create and promote a culture of civility and collegiality.

Objective: To analyze peer-to-peer positive feedback collected as part of a systematized mortality review survey to identify themes and recognition dynamics that can inform positive organizational culture change.

Design: Convergent mixed-methods study design.

Long-Term Sustainability and Adaptation of I-PASS Handovers.

Background: Inadequate communication during transitions of care is a major health care quality and safety vulnerability. In 2013 Massachusetts General Hospital (MGH) embarked on a comprehensive training program using a standardized handover system (I-PASS) that had been shown to reduce adverse events by 30% even when not completely executed on each patient. In this cross-sectional study, the authors sought to characterize handover practices six years later.

Development and Implementation of a Practical Onboarding Curriculum for Physician Quality and Safety Leaders.

Physicians are increasingly asked to assume quality and safety (Q&S) leadership roles; prior experience varies, and onboarding training is limited. Semistructured interviews were completed with physician Q&S leaders; interview responses were analyzed using 2-step rapid analysis. Interview learnings informed development of a 2-day onboarding training and complementary digital resource repository.

The Safety of Inpatient Health Care.

Background: Adverse events during hospitalization are a major cause of patient harm, as documented in the 1991 Harvard Medical Practice Study. Patient safety has changed substantially in the decades since that study was conducted, and a more current assessment of harm during hospitalization is warranted.

Methods: We conducted a retrospective cohort study to assess the frequency, preventability, and severity of patient harm in a random sample of admissions from 11 Massachusetts hospitals during the 2018 calendar year.

Allergy Safety Events in Health Care: Development and Application of a Classification Schema Based on Retrospective Review.

Background: Allergy safety requires understanding the operational processes that expose patients to their known allergens, including how and when such processes fail.

Objective: To improve health care safety for patients with allergies, we developed and assessed an allergy safety event classification schema to describe failures resulting in allergy-related safety events.

Methods: Using keyword searches followed by expert manual review of 299,031 voluntarily-filed safety event reports at 2 large academic medical centers, we identified and classified allergy-related safety events from 5 years of safety reports.

The association of hospital research publications and clinical quality.

Objective: To assess the quantity and impact of research publications among US acute care hospitals; to identify hospital characteristics associated with publication volumes; and to estimate the independent association of bibliometric indicators with Hospital Compare quality measures.

Data Sources: Hospital Compare; American Hospital Association Survey; Magnet Recognition Program; Science Citation Index Expanded.

Study Design: In cross-sectional studies using a 40% random sample of US Medicare-participating hospitals, we estimated associations of hospital characteristics with publication volumes and associations of hospital-linked bibliometric indicators with 19 Hospital Compare quality metrics.

An analysis of the structure and content of dashboards used to monitor patient safety in the inpatient setting.

The objective of this study is to review and compare patient safety dashboards used by hospitals and identify similarities and differences in their design, format, and scope. We reviewed design features of electronic copies of patient safety dashboards from a representative sample of 10 hospitals. The results show great heterogeneity in the format, presentation, and scope of patient safety dashboards.

Design and Implementation of a Real-time Monitoring Platform for Optimal Sepsis Care in an Emergency Department: Observational Cohort Study.

Background: Sepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment.

Objective: This study aims to design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline emergency department (ED) providers regarding adherence to bundled care.

Conducting Safety Research Safely: A Policy-Based Approach for Conducting Research with Peer Review Protected Material.

A multidisciplinary team developed a policy-based approach that provides guidance for using peer review protected information for safety research while maintaining peer review privilege. The approach includes project approval by an ad hoc review committee, signed confidentiality agreements by investigators and study staff, early removal of case identification numbers, standards for maintaining data security, and publication of aggregate data without data set sharing. By describing this procedure and embedding into an institutional policy on Data for Performance Improvement, the team encourages other institutions to develop similar policies consistent with their state regulations.

Improving Allergy Documentation: A Retrospective Electronic Health Record System-Wide Patient Safety Initiative.

Objectives: Documentation of allergies in a coded, non-free-text format in the electronic health record (EHR) triggers clinical decision support to prevent adverse events. Health system-wide patient safety initiatives to improve EHR allergy documentation by specifically decreasing free-text allergy entries have not been reported. The goal of this initiative was to systematically reduce free-text allergen entries in the EHR allergy module.

Interdisciplinary Patient Tracers: Routine, Systematic Safety Surveillance.

Patient tracers and leadership WalkRounds proactively identify quality and safety issues. However, these programs have been inconsistent in application, results, and sustainability. The goal was to identify a more consistent and efficient approach to survey health care facilities.

A description of medical malpractice claims involving advanced practice providers.

Background: The number of physician assistants (PAs) and advanced practice registered nurses (APRNs), together known as advanced practice providers (APPs), has risen dramatically. The goal is identifying characteristics of paid medical malpractice claims, in which APPs are defendants.

Methods: Retrospective cohort study using Harvard's malpractice insurer's national database.

Lessons Learned From Medical Malpractice Claims Involving Critical Care Nurses.

Background: Medical malpractice data can be used to improve patient safety.

Objective: To describe the types of harm events involving nurses that lead to malpractice claims and to compare claims among intensive care units (ICUs), emergency departments, and operating rooms.

Methods: Malpractice claims closed between 2007 and 2016 were extracted from a national database.

Body of Evidence: Do Autopsy Findings Impact Medical Malpractice Claim Outcomes?

Objective: Clinicians may hesitate to advocate for autopsies out of concern for increased malpractice risk if the pathological findings at time of death differ from the clinical findings. We aimed to understand the impact of autopsy findings on malpractice claim outcomes.

Methods: Closed malpractice claims with loss dates between 1995 and 2015 involving death related to inpatient care at 3 Harvard Medical School hospitals were extracted from a captive malpractice insurer's database.

The association of hospital teaching intensity with 30-day postdischarge heart failure readmission and mortality rates.

Objective: To investigate risk-adjusted, 30-day postdischarge heart failure mortality and readmission rates stratified by hospital teaching intensity.

Data Sources And Study Setting: A total of 709 221 Medicare fee-for-service beneficiaries discharged from 3135 US hospitals between 1/1/2013 and 11/30/2014 with a principal diagnosis of heart failure.

Study Design: Hospitals were classified as Council of Teaching Hospitals and Health Systems (COTH) major teaching hospitals, non-COTH teaching hospitals, and nonteaching hospitals.

Design and Impact of a Novel Surgery-Specific Second Victim Peer Support Program.

Background: Surgeons are prone to feelings of sadness, guilt, and anxiety when involved in major adverse events. We aimed to create and evaluate a second victim peer support program for surgeons and surgical trainees.

Study Design: The second victim peer support program was an intervention performed in the Department of Surgery at a tertiary care academic medical center.

Using Design Thinking to Improve Patient-Provider Communication in the Emergency Department.

Quality Issue: Emergency department overcrowding has been identified as a quality and patient safety concern.

Initial Assessment: The need for a project focused on mitigating risk in the setting of overcrowding was identified.

Choice Of Solution: Design thinking is an improvement methodology that uses a process that prioritizes empathy for end users and is optimal for abstract problems.

Calling on the Patient's Perspective in Emergency Medicine: Analysis of 1 Year of a Patient Callback Program.

Background: Patient-centered approaches in the evaluation of patient experience are increasingly important priorities for quality improvement in health-care delivery. Our objective was to investigate common themes in patient-reported data to better understand areas for improvement in the emergency department (ED) experience.

Methods: A large urban, tertiary-care ED conducted phone interviews with 2607 patients who visited the ED during 2015.

An Examination of Medical Malpractice Claims Involving Physician Trainees.

Purpose: To identify patient-, provider-, and claim-related factors of medical malpractice claims in which physician trainees were directly involved in the harm events.

Method: The authors performed a case-control study using medical malpractice claims closed between 2012-2016 and contributed to the Comparative Benchmarking System database by teaching hospitals. Using the service extender flag, they classified claims as cases if physician trainees were directly involved in the harm events.