Patient Safety

Our goal: Work with countries, regions, organizations, and individuals to build safety into every system of care, ensuring that patients receive the safest, most reliable care across the continuum. More >>

In the Spotlight

Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era
Referrals to specialists are on the rise, and despite the advent of electronic health records, the referral process is often hindered by ambiguity of roles, communication breakdowns, and process variations. Such difficulties can lead to missed or delayed diagnoses, delays in treatment, and other lapses in patient safety. A new IHI publication presents a nine-step, closed-loop process to standardize how primary care practitioners activate and monitor referrals to specialists.

Collaborative Improvement Positively Impacts Culture Change to Improve AMI Care
In this recent BMJ Quality & Safety article, the authors studied 10 hospitals over a two-year period to learn about the effect of collaborative improvement efforts to improve AMI care on organizational culture change. Among the organizations that successfully changed their culture, the authors saw “distinct patterns in membership diversity, authentic participation, and capacity for conflict management.”

The Link Between Physician Wellness and Patient Safety
This New York Times article discusses the link between physician wellness and patient safety, citing a growing body of research that shows “physician burnout and depression are linked to medical errors and to the kind of depersonalized care that is often both less effective and less palatable.” One study referenced in the article found that depressed residents were more likely to make medication errors and also to have the perception that they made errors even when they hadn’t. The evidence suggests that institutional-level changes, rather than provider-focused ones, are more effective and what’s needed.

Empowering Patients and Improving Safety with Patient-Facing Technologies
This recent blog from the PSNet Perspectives on Safety series discusses opportunities to leverage technology to, among other things, improve patient safety. “Enhancing patient engagement via health IT has been shown to promote patient behavior that leads to positive health outcomes, improved satisfaction and care delivery efficiency, reduced costs, and better quality of care and patient safety.”

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