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.

Patient Perspectives on Serious Illness Conversations in Primary Care.

The Serious Illness Care Program has been shown to improve quality and feasibility of value-based end-of-life conversations in primary care. To elicit patients' perspectives on serious illness conversations conducted by primary care clinicians. Telephone interviews were conducted with patients at an academic center in the United States, who had a recent serious illness conversation with their primary care clinician.

Palliative care in the emergency department: A qualitative study exploring barriers, facilitators, desired clinician qualities, and future directions.

Objective: To describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED-PC, and clinicians' perspectives on the future of ED-PC.

Method: This qualitative study using semi-structured interviews was conducted in June-August 2020. Interviews were analyzed via a two-phase Rapid Analysis.

Adapting the serious illness conversation guide for use in the emergency department by social workers.

Objective: Although important treatment decisions are made in the Emergency Department (ED), conversations about patients' goals and values and priorities often do not occur. There is a critical need to improve the frequency of these conversations, so that ED providers can align treatment plans with these goals, values, and priorities. The Serious Illness Conversation Guide has been used in other care settings and has been demonstrated to improve the frequency, quality, and timing of conversations, but it has not been used in the ED setting.

Emerging Palliative Care Innovations in the ED: A Qualitative Analysis of Programmatic Elements During the COVID-19 Pandemic.

Context: Health systems have aspired to integrate palliative care (PC) into the emergency department (ED) to improve care quality for over a decade, yet there are very few examples of implemented models in the literature. The coronavirus disease 2019 (COVID-19) pandemic led to an increase in the volume of seriously ill patients in EDs and a consequent rapid increase in PC integration in many EDs.

Objectives: To describe the new PC-ED delivery innovations that emerged during the COVID-19 pandemic.

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID.

Context: Although the importance of palliative care (PC) integration in the emergency department (ED) has long been recognized, few formalized programs have been reported, and none have evaluated the experience of ED clinicians with embedded PC.

Objectives: We evaluate the experience of ED clinicians with embedded PC in the ED during the coronavirus disease pandemic.

Methods: ED clinicians completed a survey about their perceptions of embedded PC in the ED.

Utility, Appropriateness, and Content of Electronic Consultations Across Medical Subspecialties.

Background: Electronic consultations (e-consults) can facilitate patient access to specialists, minimize travel, and reduce unnecessary in-person visits. However, metrics to enable study of e-consults and their effect on processes and patient care are lacking.

Objective: To assess novel metrics of e-consult appropriateness and utility.

The Impact of Anonymity in Emergency Medicine Morbidity and Mortality Conferences: Findings from a National Survey of Resident Physicians.

Introduction: Although the Accreditation Council for Graduate Medical Education mandates structured case review and discussion as a part of residency training, there remains little guidance on how best to structure these conferences to cultivate a culture of safety, promote learning, and ensure that system-based improvements can be made. We hypothesized that anonymous case discussion was associated with a more effective, and less punitive, morbidity and mortality (M&M) conference. Secondarily, we were interested in determining whether this core structural element was correlated with the culture of safety at an institution.

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.

Unscheduled return visits to the emergency department with ICU admission: A trigger tool for diagnostic error.

Background: It is believed that patients who return to the Emergency Department (ED) and require admission are thought to represent failures in diagnosis, treatment or discharge planning. Screening readmission rates or patients who return within 72 h have been used in ED Quality Assurance efforts. These metrics require significant effort in chart review and only rarely identify care deviations.

The Surprise Question Can Be Used to Identify Heart Failure Patients in the Emergency Department Who Would Benefit From Palliative Care.

Context: Heart failure (HF) is associated with symptom exacerbations and risk of mortality after an emergency department (ED) visit. Although emergency physicians (EPs) treat symptoms of HF, often the opportunity to connect with palliative care is missed. The "surprise question" (SQ) "Would you be surprised if this patient died in the next 12 months?" is a simple tool to identify patients at risk for 12-month mortality.

Does overlapping surgery result in worse surgical outcomes? A systematic review and meta-analysis.

Background: The practice of overlapping surgery impacts patients, providers, and policy-makers. While several studies have examined the relationship between overlapping surgery and clinical outcomes, a combined analysis of all available data has not been performed. We aimed to evaluate the impact of overlapping surgery on 30-day mortality, morbidity, and length of surgery.

Training to Improve Communication Quality: An Efficient Interdisciplinary Experience for Emergency Department Clinicians.

Patient-provider communication has been recognized as a critical area of focus for improved health care quality, with a mounting body of evidence tying patient satisfaction and provider communication to important health care outcomes. Despite this, few programs have been studied in the emergency department (ED) setting. The authors designed a communication curriculum and conducted trainings for all ED clinical staff.

72h returns: A trigger tool for diagnostic error.

Background: Patients who return to the Emergency Department (ED) within 72h of discharge are often used for ED Quality Assurance efforts, however little is known about the yield of this kind of review and the types of errors it identifies. Our objective was to identify the prevalence, types and severity of errors in these cases.

Methods: Retrospective review of patients who presented to an urban, university affiliated ED between 10/1/2012-9/30/2015 who returned within 72 h requiring hospital admission.

Incident Reporting in Emergency Medicine: A Thematic Analysis of Events.

Background: Incident reporting is a recognized tool for healthcare quality improvement. These systems, which aim to capture near-misses and harm events, enable organizations to gather critical information about failure modes and design mitigation strategies. Although many hospitals have employed these systems, little is known about safety themes in emergency medicine incident reporting.

Association of magnetic resonance imaging for back pain on seven-day return visit to the Emergency Department.

Background: The prevalence of back pain is rising, as is the use of high-cost imaging in the ED. The objective of our study was to determine if an MRI in the ED for patients with back pain resulted in a lower incidence of ED return visit and to determine if these patients had longer ED length of stay (LOS) and use of ED observation.

Methods: A retrospective cohort study of consecutive patients seen with back pain was conducted at an urban, university-affiliated ED between 1 January 2012 and 11 July 2014.

Large-scale implementation of the I-PASS handover system at an academic medical centre.

Background: Healthcare has become increasingly complex and care delivery models have changed dramatically (eg, team-based care, duty-hour restrictions). However, approaches to critical communications among providers have not evolved to meet these new challenges. Evidence from safety culture surveys, academic studies and malpractice claims suggests that healthcare handover quality is problematic, leading to preventable errors and adverse outcomes.

Mapping the process of emergency care at a teaching hospital in Ghana.

Emergency Department (ED) overcrowding has become a global concern as the number of countries with formalized emergency care systems has expanded, and the burden of trauma and non-communicable diseases in low and middle-income countries increased. In light of this, the international Emergency Medicine literature has outlined the need for operational projects in low and middle income countries which focus on the process of care. Despite this, there is limited published literature describing these types of projects.

New Mandated Centers for Medicare and Medicaid Services Requirements for Sepsis Reporting: Caution from the Field.

Background: The release of the Center for Medicare and Medicaid Service's (CMS) latest quality measure, Severe Sepsis/Septic Shock Early Management Bundle (SEP-1), has intensified the long-standing debate over optimal care for severe sepsis and septic shock. Although the last decade of research has demonstrated the importance of comprehensive bundled care in conjunction with compliance mechanisms to reduce patient mortality, it is not clear that SEP-1 achieves this aim. The heterogeneous and often cryptic presentation of severe sepsis and septic shock, along with the multifaceted criteria for the definition of this clinical syndrome, pose a particular challenge for fitting requirements to this disease, and implementation could have unintended consequences.

Impact of rapid screening for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions.

Background: A history of methicillin-resistant Staphylococcus aureus (MRSA) is a determinant of inpatient bed assignment.

Methods: We assessed outcomes associated with rapid testing and discontinuation of MRSA contact precautions (CP) in a prospective cohort study of polymerase chain reaction (PCR)-based screening in the Emergency Department (ED) of Massachusetts General Hospital. Eligible patients had a history of MRSA and were assessed and enrolled if documented off antibiotics with activity against MRSA and screened for nasal colonization (subject visit).

Supporting Medical Students' Pursuit of Longitudinal Patient Experiences: Piloting an Innovative Visit Notification Tool at the Massachusetts General Hospital.

Problem: Both medical educators and students have an increasing interest in longitudinal patient experiences (LPE) that allow students to work with patients at multiple points in time, often across multiple clinical settings. Despite this interest in LPE, following patients over time and across health systems remains a challenge.

Approach: In August 2012-May 2013, with faculty support, two third-year medical students implemented a pilot program at the Massachusetts General Hospital (MGH) in the third-year block clerkship curriculum.

An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units.

Background: Traditional methods of surveillance of catheter-associated urinary tract infections (CAUTIs) are error-prone and resource-intensive. To resolve these issues, we developed a highly sensitive electronic surveillance tool.

Objective: To develop an electronic surveillance tool for CAUTIs and assess its performance.