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April 17, 2018
More on Tests Pending at Discharge
The problem of significant abnormal test results “slipping through the cracks” is a serious cause for preventable adverse patient outcomes and a leading cause of malpractice settlements. A subset of this problem has to do with “tests pending at discharge”. This refers to tests that were performed during an inpatient hospitalization for which the formal interpretive report has not been completed before the patient is discharged from the hospital. We’ve discussed this in our Patient Safety Tips of the Week for March 1, 2011 “Tests Pending at Discharge” and August 21, 2012 “More on Missed Followup of Tests in Hospital” and the list of other columns below.
In our March 1, 2011 Patient Safety Tip of the Week “Tests Pending at Discharge” we discussed a systematic review on the safety implications of missed test results in hospitalized patients (Callen 2011). This is an issue we have harped upon in many previous columns and the findings in the new review are no less frightening. They found lack of followup on test results ranged from 20-60% for inpatients and 1-75% for emergency room patients. And the lack of followup had clinical implications since some of the results were considered critical or urgent or otherwise actionable.
A couple factors in recent decades have contributed to this problem. One is the pressure to shorten hospital lenghs of stay. The second has to do with the widespread adoption of hospitalist programs. Don’t get us wrong. We love hospitalists! But the nature of hospitalist scheduling often leads to reports being sent to a hospitalist who will not be at the hospital for a considerable period of time or even never again. In our March 9, 2010 Patient Safety Tip of the Week “Communication of Urgent or Unexpected Radiology Findings” we noted a study (Were et al 2009) which showed that only 16% of tests with results pending actually are documented in discharge summaries. They identified multiple changes in attendings as an issue and difficulty identifying the physician who will ultimately follow the patient after discharge. We also noted in our October 13, 2009 Patient Safety Tip of the Week “Slipping Through the Cracks that studies have shown sending reports to two physicians, rather than increasing the likelihood someone will follow up, actually doubles the risk that no one will follow up (Singh 2009)!
Dalal and colleagues (Dalal 2018) at Brigham and Women’s Hospital (Partners HealthCare) recently reported results of a cluster-randomized controlled trial assessing the impact of automated notification of tests pending at discharge (TPAD’s) on documented follow-up in the EHR. (Note that we’ve described some of the design and implementation of such systems by Dalal and colleagues (Dalal 2011, Dalal 2012) in previous columns.)
Patients discharged from general medicine and cardiology services with at least one TPAD between June 2011 and May 2012 were assigned to intervention or usual care groups based upon the randomization status of their discharging attending and PCP. They adapted an established algorithm to identify actionable TPAD’s. All normal, near-normal, and benign results were excluded. 7.5% of all TPAD’s sampled were determined to be actionable and underwent subsequent chart review. Examples of actionable TPAD’s include malignant cells in pericardial fluid cytology, low vitamin D level, HIV genotype, positive urine culture, low protein C level, gastric biopsy positive for H. pylori, and positive hepatitis C antibody. Most commonly documented actions included establishing, changing, or confirming a diagnosis and communicating results with the patient.
Most TPAD’s were generated on patients discharged from general medicine services. The most frequent test type was chemistry/hematology. Most discharging attendings were male and had 5 years or less of experience. 66% of patients had non-network PCP’s. The proportion of actionable TPAD’s listed as pending in the discharge summary was 50.7% and 49.5% in the intervention and control groups, respectively.
The proportion of actionable TPAD’s with documented action was not statistically different for the intervention arm compared to usual care (60.7 vs. 56.3%). But almost all (97.4%) instances in the intervention arm who had action had evidence of documented action on the same day.
The proportion of actionable TPADs with documented action was significantly higher for pathology compared to other test types (77.2 vs. 48.5%). There was a non-significant trend towards increased proportion of actionable TPADs with documented action for patients discharged by hospitalists compared to non-hospitalists (62.3 vs. 54.4%). There was a significantly greater impact of the intervention on documented follow-up of actionable TPAD’s among patients with network PCPs (70 vs. 50%). There was no evidence of effect modification of the intervention by clinical service, provider type or experience, test type, or number of actionable TPAD’s per patient.
Even with the automated notification system there were still approximately 40 percent of patients who had no evidence of documented follow-up for actionable TPAD’s, including several patients with biopsy specimens that revealed malignancies.
The proportion of actionable TPAD’s lacking documented follow-up was 39.9% for acknowledgment, and 41.1% for action. Types of actionable TPADs without documented follow-up included abnormal vitamin levels (n = 25), pathology specimens (n = 15, including 6 malignancies); abnormal rheumatology titers (n = 9, including an extremely elevated anti-DS DNA titer); abnormal endocrine results (n = 8); abnormal viral tests (n = 8, including an elevated HCV viral load); positive microbiology cultures (4); and miscellaneous (32)
Notably their healthcare system also had separate notification systems running in parallel for pathology and radiology. The authors suspect that may account for the higher proportion of pathology follow up action documented and for the very low number of radiology TPAD’s identified (most significant radiology TPAD’s were identified prior to discharge).
Note that this study only included patients who were inpatients. It did not address the issue of patients seen in the ED and discharged before official reports of all tests were done. The ED is particularly vulnerable because the individual ED physician may not be returning to the hospital soon (or never in some circumstances). So the ED medical director or his/her designee must be assigned the task of going over the previous day’s tests to ensure no test results are “pending” and have not been acknowledged by the original ED physician. Similarly, particularly for radiology studies, each facility must have a system in place a system where the ED physician’s interpretation of an imaging study is reconciled with the official radiology report and any discrepancies get back to a party in position to take appropriate follow up action.
The other issue it does not address is the amended report. We discussed that in our Patient Safety Tips of the Week for October 2, 2012 “Test Results: Everyone’s Worst Nightmare” and March 12, 2013 “More on Communicating Test Results”. Each facility must have in place a system in which any report that is amended gets conveyed to a party responsible for the patient.
Although the study did not show significant improvement in the proportion of actionable TPAD’s with documented follow-up, they did observe significant improvement in time to documented follow-up favoring the intervention.
The study does demonstrate that the system designed at the Brigham resulted in significant improvement in documented follow-up for patients of network PCP’s and shortened the time to follow up action. One other positive aspect of the study is that Partners HealthCare clearly has a good algorithm for identification of potentially actionable TPAD’s (tests pending at discharge). In our Patient Safety Tip of the Week August 21, 2012 “More on Missed Followup of Tests in Hospital” we discussed some of the barriers to identifying all those pending test results and in being able to attribute responsibility for followup to the correct party.
Also, since the Brigham is a tertiary referral center and a very high percentage of inpatients were non-network patients (66% of their patients had non-network PCP’s), it might be anticipated that a system like theirs might be more effective in hospitals that have a higher proportion of in-network patients and PCP’s, such as community hospitals.
It's also encouraging that the systems for communicating significant results for radiology and pathology seem to be working well at the Brigham.
And it's encouraging that the percentage of discharge summaries identifying tests pending at discharge has improved since our original columns (the proportion of actionable TPAD’s listed as pending in the discharge summary was 50.7 and 49.5% in their intervention and control groups, respectively). But that’s still short of the 100% target we have.
But the Brigham study found that about 40% of actionable TPAD’s did not have follow-up documented in the EHR, including a few high-risk results such as malignancies. The study shows that we still have a big gap in “closing the loop” on test results when patients are discharged prior to official test result reports being available.
To address this gap, Dalal and team envision integration of newer digital health tools with the hospital's electronic health record that not only notifies discharging attending physicians and primary care physicians, but that empowers patients to make sure their test results are followed-up in a timely manner. They note that most major EHR vendors can extend existing functionality to externally notify clinicians of actionable TPAD’s via institutional email, secure messaging, or mobile app “push” notifications. They can also flag importance in subject headings or notification banners, facilitate knowledge transfer between key inpatient and ambulatory clinicians; and request acknowledgment electronically.
See also our other columns on communicating significant results:
References:
Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf 2011; 20: 194-199 Published Online First: 7 February 2011
http://qualitysafety.bmj.com/content/20/2/194.full.pdf
Were MC, Li X, Kesterson J, et al. Adequacy of Hospital Discharge Summaries in Documenting Tests with Pending Results and Outpatient Follow-up Providers. Journal of General Internal Medicine 2009; 24(9): 1002-1006
http://springerlink.com/content/57u6374273282457/?p=8d1facb4fd6c402a9b895f3a46a59022&pi=1
Singh H, Thomas EJ, Mani S, et al. Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting. Arch Intern Med. 2009; 169(17): 1578-1586.
http://archinte.ama-assn.org/cgi/content/short/169/17/1578?home
Dalal AK, Schaffer A, Gershanik EF, et al. The Impact of Automated Notification on Follow-up of Actionable Tests Pending at Discharge: a Cluster-Randomized Controlled Trial, Journal of General Internal Medicine 2018; Published online 12 March 2018
https://link.springer.com/article/10.1007%2Fs11606-018-4393-y
Dalal AK, Schnipper JL, Poon EG, et al. Design and implementation of an automated email notification system for results of tests pending at discharge. J Am Med Inform Assoc 2012; 19(4): 523-528
http://jamia.bmj.com/content/19/4/523.abstract?sid=e567bfae-e816-4f48-8080-36ee4119062d
Dalal AK, Schnipper JL, Poon EG, et al. Design and implementation of an automated email notification system for results of tests pending at discharge. J Am Med Inform Assoc 2012; 19(4): 523-528
http://jamia.bmj.com/content/19/4/523.abstract?sid=e567bfae-e816-4f48-8080-36ee4119062d
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April 2018
Disclosure and apology after an adverse medical event where errors contributed is not only the right thing to do, it also likely results in lower liability costs. Our numerous columns on the issue are listed below. Disclosure and apology has evolved into “communication-and-resolution programs”. Such programs communicate with patients when adverse events occur, investigate and explain what happened and, where appropriate, apologize and proactively offer compensation.
Our most recent columns on the issue (our October 2017 What's New in the Patient Safety World column “More Support for Disclosure and Apology” and January 3, 2017 Patient Safety Tip of the Week “What’s Happening to “I’m Sorry”?”) discussed not only successes of such programs but also barriers to successful implementation.
A new study further demonstrates the success of communication and resolution programs (CRP). LeCraw and colleagues compared liability outcomes before and after collaborative communication resolution program implementation at a health system in Tennessee (LeCraw 2018). 43% of events with injury from medical error were resolved with apology alone. Compared to pre-implementation levels, there was a decrease in the average number of new claims filed (1.07 to .36), defense costs ($41,950 to $20,623), settlement costs ($19,480 to $14,228), and total liability costs ($61,430 to $34,851) under collaborative communication resolution program all measured per 1000 hospital admissions.
No medical error occurred in 65% of adverse events. One percent of adverse events when there was no medical error received compensation.
Moreover, the median time interval to resolve a claim decreased from 17 months to 8 months, a reduction of 53%.
The LeCraw paper describes the CRP process in detail:
At an initial meeting patient or family members tell their story and describe the impact of the event. Family members and/or attorneys are welcome at all meetings and the involved physician or other healthcare provider representatives are encouraged to attend. The primary goal of the initial meeting is to listen and learn about the patient’s questions and concerns. Risk Management (RM) staff describes the resolution process and answers any questions about it.
The reported event is then investigated through the hospital’s usual incident investigation processes. A second meeting takes place between one week and one month after the first. Again, involved physicians may be invited to attend the second meeting. RM reviews the discussion from the first meeting and invites the patient to provide any updates. All non-privileged information about the incident is disclosed to the patient. An effort is made to reconcile the patient’s version of events with the one ascertained through the QI investigation. RM staff answers any remaining questions and agrees to investigate further any unanswered questions.
A patient who is satisfied with the results of the investigation may wish to conclude the meeting without making any requests. The study found that in cases where the patient feels that a medical error took place, the most common requests are for an apology, explanation of the adverse outcome, and some change in hospital policy or operations. If the adverse outcome was the result of medical error, the error is acknowledged and a sincere apology is given, along with a commitment to change hospital policies to prevent or minimize the chances of reoccurrence. (The hospital is only able to address those ele-
ments involving the hospital, unless the physician agrees to participate.) If compensation is requested by the patient for an adverse outcome due to medical error, the patient is wsked to give a breakdown of the amount of compensation requested. RM presents this information to the CC which determines their value for the injury and an amount to offer as compensation.
If the investigation determines no medical error occurred, an explanation is made for the adverse outcome and why the hospital believes the standard of care was not breached. Any request for compensation is denied. RM staff continues to answer the patient’s clarifying questions and may offer to participate in mediation if the patient is not satisfied with the explanation. There is also the potential for a patient who disagrees to initiate a formal legal claim.
When a medical error occurred and compensation is requested, a third meeting is proposed no more than 90 days following initial contact with the patient. Any changes to hospital policy or procedures resulting from the incident are explained to the patient/family with an explanation of how the changes are expected to prevent a recurrence. If the patient accepts the offer of compensation and/or the hospital’s efforts to change policy, a settlement document is signed. If the offer is rejected, RM staff may offer to participate in mediation. If all these effortsare unsuccessful, the patient may still pursue a formal legal claim.
The results achieved in this CRP program are very reassuring. Also, since attorneys were involved in 60% of the above events, the success reported should be encouraging to physicians and hospitals alike. Disclosure and sincere apology go a long way to mend fences when adverse events occur and it’s becoming increasingly clear that full “communication-and-resolution programs” are satisfying to hospitals and patients/families and less costly in the long run.
Some of our prior columns on Disclosure & Apology:
July 24, 2007 “Serious Incident Response Checklist”
June 16, 2009 “Disclosing Errors That Affect Multiple Patients”
June 22, 2010 “Disclosure and Apology: How to Do It”
September 2010 “Followup to Our Disclosure and Apology Tip of the Week”
November 2010 “IHI: Respectful Management of Serious Clinical Adverse Events”
April 2012 “Error Disclosure by Surgeons”
June 2012 “Oregon Adverse Event Disclosure Guide”
December 17, 2013 “The Second Victim”
July 14, 2015 “NPSF’s RCA2 Guidelines”
June 2016 “Disclosure and Apology: The CANDOR Toolkit”
August 9, 2016 “More on the Second Victim”
January 3, 2017 “What’s Happening to “I’m Sorry”?”
October 2017 “More Support for Disclosure and Apology”
Other very valuable resources on disclosure and apology:
References:
LeCraw FR, Montanera D, Jackson JP, et al. Changes in liability claims, costs, and resolution times following the introduction of a communication-and-resolution program in Tennessee. Journal of Patient Safety and Risk Management 2018; First Published February 14, 2018; 23(1): 13-18
http://journals.sagepub.com/doi/full/10.1177/1356262217751808
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The Joint Commission recently published a Quick Safety Issue on supporting second victims (TJC 2018). Our multiple columns on “the second victim” (see list at the end of today’s column) discuss the evolution of the approach to helping second victims. Back in the early 1990’s as we began dealing with investigations on serious events we recognized that those healthcare workers involved in serious events, either directly or indirectly, often had difficulty coping in the aftermath of such events. So we added a specific item to our Serious Incident Checklist for paying attention to any second victims.
The Joint Commission document notes that it is estimated that nearly half of health care providers could experience the impact as a second victim at least once in their careerand that a 2014 survey of 1,755 physicians outside the U.S. found most physicians had been involved in a serious safety event and most admitted to experiencing second victim effects.
TJC notes most hospitals make the same mistake we made in the early days of patient safety:,we often simply made available to them professional assistance (employee assistance programs or psychological counselling). Over the years, helping the “second victim” has evolved considerably and such referral for professional help is not a good first line strategy and may even be counterproductive. Support from peers is extremely important if such programs are to be successful.
TJC has the following recommendations:
It goes on to describe components your organization should include if you have, or decide to create, a second victim program:
Our August 2017 What's New in the Patient Safety World column “ROI for a Second Victim Program” focused on Johns Hopkins’ RISE (Resilience In Stressful Events) program and showed how the efforts made were likely very cost effective (Moran 2017). In our August 9, 2016 Patient Safety Tip of the Week “More on the Second Victim” and several other columns we also highlighted the work of Susan Scott and colleagues at the University of Missouri and their MITSS (Medically Induced Trauma Support Services) program.
Second victim programs are essential to any organization that has a good culture of safety. We hope you’ll go to our previous columns on such programs to see the details of what is involved in such programs.
Some of our prior columns on “the second victim”:
References:
TJC (The Joint Commission). Quick Safety Issue 39: Supporting second victims. January 22, 2018
Johns Hopkins’ RISE (Resilience In Stressful Events) program
https://www.johnshopkinssolutions.com/solution/rise-peer-support-for-caregivers-in-distress/
Moran D, Wu AW, Connors C, et al. Cost-Benefit Analysis of a Support Program for Nursing Staff. Journal of Patient Safety 2017; Post Author Corrections: April 27, 2017
MITSS (Medically Induced Trauma Support Services)
http://www.mitsstools.org/index.html
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We don’t tend to focus on one disease in most of our columns. But there is one particular disease in which we see numerous complications in hospitalized patients – Parkinson’s Disease (PD). That is because patients with Parkinson’s are often on medications that are relatively unfarmiliar to inpatient staff and are often on dosing frequency regimens that don’t fit well with the routines used in hospitals. In addition, many medications commonly used during hospitalizations may exacerbate symptoms of Parkinson’s. And clinical aspects of Parkinson’s may predispose to many other adverse events in a hospital, including aspiration, falls, DVT, and other complictions related to immobility. Add to that the autonomic dysfunction seen is some Parkinson’s patients (and more so in some Parkinson-look-alikes such as Multiple System Atrophy).
We’ve done several columns, listed below, addressing some of the problems encountered in Parkinson’s patiens when inpatients. But we have not yet addressed surgery and anesthesia. A new study has looked at considerations for general anesthesia in Parkinson’s patients (Roberts 2018).
Neurology Advisor (Rodriguez 2018) interviewed on of the authors (SJG Lewis) of that review and he had several important recommendations. First is to continue the usual drug regimen until just before the induction of anesthesia. This is especially critical in patients taking levodopa because of the drug's short half-life. During procedures requiring extended anesthesia, he notes that levodopa can be administered by means of a nasogastric tube. Second, propofol has been reported to demonstrate dyskinetic effects in individuals with and without movement disorders, including PD, so clinicians should remain aware of the increased risk for propofol-induced dyskinesia in deciding whether use of Propofol is appropriate or not. Third, PD patients often have sialorrhea caused by impaired swallowing and this may worsen during anesthesia. Glycopyrrolate by mouth and ipratropium spray have been shown to be effective in short-term treatment of sialorrhea.
Several commonly used general anesthetic agents, such as halothane and isoflurane, may influence dopamine transmission. In addition, they note that halothane has been reported to increase cardiac sensitivity to catecholamines and should not be used in patients taking levodopa. Sevoflurane, enflurane, and isoflurane have been suggested as safer alternatives to halothane.
They also stress that the timing of medications pre- and post-surgery, is important and that the PD patient is at risk for neuropsychiatric problems such as psychosis and confusion. If the patient is likely to receive alimentation by mouth for a few days postoperatively, clinicians will need to think about managing the administration of PD medications. Careful assessment of the PD patient for delirium and agitation is needed and there should be a plan across specialties for prevention and management of delirium and/or hallucinations.
There should also be a clear plan for safe rehabilitation of the patient.
In our three previous columns on PD inpatients, we’ve stressed that most hospital staff may be unfamiliar not only with medications taken by PD patients (some of which may not even be on the hospital formulary) but also with the unique dosing frequencies needed. The very precise timing of doses is problematic for most hospitals and hospital units because they are used to their own standardized times for medication dispensing and administration. And most anti-Parkinsonian medications are available only in oral form so it is especially problematic when the patient is NPO or is otherwise unable to swallow. Some anti-Parkinson’s formulations are also of the extended-release variety and should not be crushed. Moreover, drugs that worsen extrapyramidal function are often used in the hospital and these may significantly worsen Parkinsonian features. Patients with Parkinson’s also seem to get temporary declines in function when they get a systemic problem, like an infection.
Our June 2015 What's New in the Patient Safety World column “More Risks for Parkinson Inpatients” highlighted some recommendations ISMP (ISMP 2015) made for PD inpatients. Hospitals should expedite medication reconciliation and avoid delays in obtaining nonformulary drugs. They should build computerized alerts to avoid disease-medication interactions or drug-drug interactions. Each PD iinpatient should have a unique medication administration schedule and drugs known to worsen PD should be avoided, and sudden cessation of PD meds should be avoided. ISMP noted the importance of both patient and focused staff education and noted neurology consultation is advisable.
The advice in today’s column regarding the anesthesia considerations should be added to the complexities of managing PD inpatients. We’d strongly advise that your neurology staff lead an interdisciplinary team and establish protocols and training for dealing with PD patients who need hospitalization and/or surgery.
Our prior columns on problems related to Parkinson’s Disease patients as inpatients:
References:
Roberts DP, Lewis SJG. Considerations for general anaesthesia in Parkinson's disease. J Clin Neurosci 2018; 48: 34-41
http://www.jocn-journal.com/article/S0967-5868(17)31191-8/fulltext
Rodriguez T. Anesthesia in Parkinson Disease Requires Cautious Care. Neurology Advisor 2018; February 09, 2018
ISMP (Institute for Safe Medication Practices). Delayed administration and contraindicated drugs place hospitalized Parkinson’s disease patients at risk. ISMP Medication Safety Alert! Acute Care Edition. March 12, 2015
http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=103
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One of our most frequent topics has been the impact of fatigue on performance and its contribution to medical errors. No one is immune to the detrimental effect of fatigue on performance and it’s no different for radiologists. A recent study (Hanna 2018) used a tool for measuring fatigue and advance eye tracking technology to assess the performance of radiologists (both attendings and residents). The goal was to determine the effect of overnight shifts on performance.
During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. The Swedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after overnight shifts. Not surprisingly, participants demonstrated worse diagnostic performance in the fatigued versus not fatigued state. Viewing time per case was significantly prolonged when the radiologists were fatigued. Mean total fixations generated during the search increased by 60% during fatigued sessions. Mean time to first fixate on bone fractures increased by 34% during fatigued sessions. Moreover, dwell times associated with trueand false-positive decisions increased, whereas those with false negatives decreased. Effects of fatigue were more pronounced in residents.
The authors conclude that further research is needed to address and reverse the impact of such fatigue-related changes. They speculate that environmental changes (eg. lighting) and activity changes (eg. periodic breaks, moving around, etc.) might help mitigate the adverse effects of fatigue on performance.
Some of our other columns on the role of fatigue in Patient Safety:
November 9, 2010 “12-Hour Nursing Shifts and Patient Safety”
April 26, 2011 “Sleeping Air Traffic Controllers: What About Healthcare?”
February 2011 “Update on 12-hour Nursing Shifts”
September 2011 “Shiftwork and Patient Safety
November 2011 “Restricted Housestaff Work Hours and Patient Handoffs”
January 2012 “Joint Commission Sentinel Event Alert: Healthcare Worker Fatigue and Patient Safety
January 3, 2012 “Unintended Consequences of Restricted Housestaff Hours”
June 2012 “June 2012 Surgeon Fatigue”
November 2012 “The Mid-Day Nap”
November 13, 2012 “The 12-Hour Nursing Shift: More Downsides”
July 29, 2014 “The 12-Hour Nursing Shift: Debate Continues”
October 2014 “Another Rap on the 12-Hour Nursing Shift”
December 2, 2014 “ANA Position Statement on Nurse Fatigue”
August 2015 “Surgical Resident Duty Reform and Postoperative Outcomes”
September 2015 “Surgery Previous Night Does Not Impact Attending Surgeon Next Day”
September 6, 2016 “Napping Debate Rekindled”
April 18, 2017 “Alarm Response and Nurse Shift Duration”
July 11, 2017 “The 12-Hour Shift Takes More Hits”
Some of our other columns on housestaff workhour restrictions:
December 2008 “IOM Report on Resident Work Hours”
February 26, 2008 “Nightmares: The Hospital at Night”
January 2010 “Joint Commission Sentinel Event Alert: Healthcare Worker Fatigue and Patient Safety
January 2011 “No Improvement in Patient Safety: Why Not?”
November 2011 “Restricted Housestaff Work Hours and Patient Handoffs”
January 3, 2012 “Unintended Consequences of Restricted Housestaff Hours”
June 2012 “Surgeon Fatigue”
November 2012 “The Mid-Day Nap”
December 10, 2013 “Better Handoffs, Better Results”
April 22, 2014 “Impact of Resident Workhour Restrictions”
January 2015 “More Data on Effect of Resident Workhour Restrictions”
August 2015 “Surgical Resident Duty Reform and Postoperative Outcomes”
September 2015 “Surgery Previous Night Does Not Impact Attending Surgeon Next Day”
March 2016 “Does the Surgical Resident Hours Study Answer Anything?”
Our previous columns on the 12-hour nursing shift:
November 9, 2010 “12-Hour Nursing Shifts and Patient Safety”
February 2011 “Update on 12-hour Nursing Shifts”
November 13, 2012 “The 12-Hour Nursing Shift: More Downsides”
July 29, 2014 “The 12-Hour Nursing Shift: Debate Continues”
October 2014 “Another Rap on the 12-Hour Nursing Shift”
December 2, 2014 “ANA Position Statement on Nurse Fatigue”
September 29, 2015 “More on the 12-Hour Nursing Shift”
July 11, 2017 “The 12-Hour Shift Takes More Hits”
References:
Hanna TN, Zygmont ME, Peterson R, et al. The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance. J Am Coll Rad 2018; Article in Press January 21, 2018
http://www.jacr.org/article/S1546-1440(17)31661-7/fulltext
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Print “April 2018 What's New in the Patient Safety World (full column)”
Print “April 2018 More Support for Communication and Resolution Programs”
Print “April 2018 Joint Commission and the Second Victim”
Print “April 2018 Anesthesia in Parkinson’s”
Print “April 2018 Radiologists Get Fatigued, Too”
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