Open access

NEWS - Patient Safety & Quality

New Guide to Infection Control in The Hospital – International Society for Infectious Diseases (free)

A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.


Opioid Wisely – Choosing Wisely Canada (free)

Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)

See complete lists from Choosing Wisely U.S. / Choosing Wisely UKChoosing Wisely Australia AND Choosing Wisely Canada

This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.


Patterns and Predictors of Short-Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study – Journal of Hospital Medicine (free PDF)

Commentary: Short-term use of IV devices is common — and risky — study shows – University of Michigan, via ScienceDaily (free)

“Intravenous devices known as PICCs should be reserved for long-term use, but a new study shows 1 in 4 are used for 5 days or less” (from ScienceDaily)


Compassionate leadership has a pivotal role in tackling bullying in healthcare – The BMJ Opinion (free)

“Negative staff experiences are often a precursor for negative patient experiences”.


Editor’s Choice: There but for the grace of God . . . – The BMJ (free)

About liability and error in medical practice.


E-learning for health professionals – Cochrane Library (link to abstract – $ for full-text)


Weekend Surgical Care and Postoperative Mortality: A Systematic Review and Meta-Analysis of Cohort Studies (free)

Commentary: Evidence Supports ‘Weekend Effect’ for Mortality after Surgery – Wolters Kluwer, via NewsWise (free)

“The odds of postoperative mortality were 27 percent higher for patients admitted to the hospital on Saturday or Sunday, compared to those hospitalized on a weekday” (from NewsWise).


Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis – BMC Medicine (free)

Commentary : Age itself is not a risk factor for complications after surgery among older patients – OnMedica (free)

“Q: What predicts poor outcome after elective surgery in older people?

A: Frailty, cognitive impairment, depression, smoking but NOT age per se”. (via @trishgreenhalgh see Tweet)


Can Your Hip Replacement Kill You? – The New York Times (10 articles per month are free)

“Lawsuits are pulling back the curtain on what some doctors call the Wild West of medicine: the untested and largely unregulated medical device industry” (via @NYTHealth see Tweet)


What physicians can do about ransomware – ACP Hospitalist (free)

“Protecting a practice doesn’t always require a large investment of money, just time and employee training”.


Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults – Journal of the American Geriatrics Society (link to abstract – $ for full-text)

“Interventions designed to optimize medication use reduced the risk of any and serious ADRs in older adults. Implementation of these successful interventions in healthcare systems may improve medication safety in older adults”.


Why American doctors keep doing expensive procedures that don’t work – VOX (free)

“The proportion of medical procedures unsupported by evidence may be nearly half”.


The struggle to do no harm in clinical trials – Nature (free)

“The struggle to do no harm: the unexplained deaths in #cancer immunotherapy trials” (via @EricTopol see Tweet)


Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently – NIHR Signal (free)

Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (free summary – $ for full-text) AND News Release: Comprehensive geriatric assessment for older adults admitted to hospital (free)

“Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently” (RT @NIHR_DC see Tweet)


Outcomes In Two Massachusetts Hospital Systems Give Reason For Optimism About Communication-And-Resolution Programs – Health Affairs (link to abstract – $ for full-text)

Commentaries: After medical error, apology goes a long way – Stanford University Medical Center, via ScienceDaily (free) AND Conflict Resolution Program: ‘Cause for Optimism’ – MedPage Today (free registration required)


Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study – The BMJ (free)

“Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations”.


Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (free)

Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (link to abstract – $ for full-text)

Related: Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

“Older patients are more likely to be alive and in their own homes at follow-up if they received comprehensive geriatric assessment on admission to hospital”.


Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)

“Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery” (RT @NIHR_DC see Tweet)


Factors Associated With Choice of Infant Sleep Position – Pediatrics (free)

Commentaries: Less than half of mothers place sleeping infants supine – 2 Minute Medicine (free) AND Most moms aren’t putting babies to sleep safely, study says – CNN (free) AND Less Than Half of Mothers Report Always Putting Babies to Sleep in Supine Position – Physician’s First Watch (free) AND Parents still failing to put babies to sleep on their backs – Reuters (free)

Placing infants in the supine position for sleep reduces the risk of sudden unexpected infant death and has been recommended by the American Academy of Pediatrics since 2005. Nevertheless, in this survey only 43,7% of mothers placed their infants exclusively in supine position for sleep.


When surgery is just a stitch-up – The Guardian (RT @Onisillos  see Tweet)

Related article: Use of placebo controls in the evaluation of surgery: systematic review – The BMJ (free)

“With evidence mounting that many minor operations owe their success to the placebo effect, is it time to call a halt to some routine procedures?”


Acute Kidney Injury After Computed Tomography: A Meta-analysis – Annals of Emergency Medicine (link to abstract – $ for full-text)

Commentary: When kidneys are injured, CT contrast isn’t the culprit – Health Imaging (free)

Related article: Risk of Acute Kidney Injury After Intravenous Contrast Media Administration – Annals of Emergency Medicine (free)

Source: Hospital Medicine Virtual Journal Club

Compared with noncontrast CT, contrast-enhanced CT was not significantly associated with either acute kidney injury, need for renal replacement therapy, or all-cause mortality.


Updated: Practice Parameters and Technical Standards – American College of Radiology (free)

News release: New, Revised Guidance Documents Cover 35 Radiology Topics – American College of Radiology, via NewsWise (free)

The American College of Radiology developed 3 new guidance documents and revised 32 others to advance the science of radiology and improve the quality of service to patients


Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis – PLOS One (free)

This systematic review and meta-analysis mostly of observational studies suggests early breastfeeding initiation is associated with increased survival. The authors acknowledge that there are many reasons for delayed breastfeeding initiation that may confound the relationship between breastfeeding initiation and mortality, but remember that randomized trials would not be considered ethical, so we must rely on high quality observational data. Based on their analysis, the authors suggest the implementation of programs that emphasize the importance of early initiation of breastfeeding, in addition to promoting exclusive breastfeeding.


What do hypnotics cost hospitals and healthcare? – F1000 Research (free)

Source: Hospital Medicine Virtual Journal Club

“A best estimate is that U.S. costs of hypnotic harms to healthcare systems are on the order of $55 billion, but conceivably might be as low as $10 billion or as high as $100 billion”.


A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission – BMJ Open (free) (RT @NIHR_DC)

Alternatives to hospital admission for people aged over 65 years can be safe and reduce costs across a range of acute and chronic conditions.


Too Many Meds?

5 Aug,2017

Too Many Meds? America’s Love Affair With Prescription Medication – Consumer Reports (free)

See more on “Deprescribing” in our May 8th issue (see #7), May 9th issue (see #4) and May 15th issue (see #2), and also a related article on Current and future perspectives on the management of polypharmacy

“Yes. Way Too Many Meds. Think De-prescribe”. (RT @EricTopol see Tweet)


Discover and defeat your diagnostic errors – ACP Internist (free) (RT @acpinternist  see Tweet)

“Experts explain the causes and solutions for common mistakes in diagnosis”.


Iatrogenesis in Pediatrics – AMA Journal of Ethics (free) (RT @JournalofEthics)

New issue with series of articles exploring strategies clinicians need to know to respond to adverse outcomes.


Risk Factors for Emergency Department Visits After Hysterectomy for Benign Disease – Obstetrics & Gynaecology (free PDF)

Commentaries: Emergency Visits Common After Hysterectomy, Study Finds – Medscape (free registration required) AND ~10 Percent Present to ER After Hysterectomy for Benign Disease – Physician’s Briefing (free)
“Risk factors include younger age, higher parity, Medicare or self-pay insurance, postoperative pain” (from Physician’s Briefing)


American College of Surgeons (ACS) 2017 Quality and Patient Safety Conference: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free)

Related guideline: Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)

See other Enhanced Recovery After Surgery (ERAS) Guidelines and Reviews in our collection and in the ERAS Society Website.

“Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure”


2017 ACS Quality and Safety Conference: “Strong for Surgery” Shows Promise in Reducing Smoking Rates for Patients Facing Surgery – American College of Surgeons, via NewsWise (free)

“Study suggests big drop in smoking rates when surgeons help patients quit before their operations”.


Effects of control interventions on Clostridium difficile infection in England: an observational study – The Lancet Infectious Diseases (free)

Invited Commentary: Fluoroquinolone restriction to control fluoroquinolone-resistant Clostridium difficile (free)

“Very important finding! Restricting fluoroquinolones more important than infection control measures to prevent CDI” (RT @sanjaysaint see Tweet)


Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)

This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.


Effectiveness of Pharmacist Intervention to Reduce Medication Errors and Health-Care Resources Utilization After Transitions of Care: A Meta-analysis of Randomized Controlled Trials – Journal of Patient Safety (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)

Pharmacist transition of care intervention seems to be an effective strategy to reduce medication errors after hospital discharge and to reduce subsequent emergency room visits.


Poor-Quality Medicine: A Global Pandemic – Devex (free)

“Each year, the proliferation of substandard and falsified medicines puts the lives of millions of people – particularly those living in developing countries – at risk”


Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Comparative Effectiveness Review – Agency for Healthcare Research and Quality (free report and summary)

See also: Executive summary (free PDF)

Source: ACP Journal Wise ($ resource to find articles of interest)

Comprehensive review on the evidence regarding thromboembolism prophylaxis in major orthopedic surgery.


Use of antibiotics during pregnancy and the risk of major congenital malformations: A population based cohort study – British Journal of Pharmacology (link to abstract – $ for full-text)

Commentary: New study finds link between certain antibiotics during pregnancy and risk for birth defects – News Medical (free)

Related article: Use of antibiotics during pregnancy and risk of spontaneous abortion – Canadian Medical Association Journal (free)

In this large cohort clindamycin, doxycycline, quinolones, macrolides, and phenoxymethylpenicillin were associated with congenital malformations. Amoxicillin, cephalosporins, and nitrofurantoin were not associated with birth defects.


Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery – British Journal of Surgery (link to abstract – $ for full-text)

Source: ACP Journal Club ($ resource to find articles of interest)

In this RCT, a comprehensive preoperative geriatric assessment and optimization before vascular surgery was associated with shorter length of hospital stay, lower incidence of complications, and patients were less likely to be discharged to a higher level of dependency.


Longitudinal Patterns of Medication Nonadherence and Associated Health Care Costs – Inflammatory Bowel Diseases (link to abstract – $ for full-text)

Commentary: Taking medications as prescribed important to control health care costs – Cincinnati Children’s Hospital Medical Center, via EurekAlert (free)

In this small study, patients with increasing nonadherence over time demonstrate more than a 3-fold increase in costs compared with adherent patients.


Viewpoint: Contact Precautions for Endemic MRSA and VRE: Time to Retire Legal Mandates – JAMA (free)

“Contact precautions are easy to use w a single patient, but burdensome when applied to an entire hospital” (RT @JAMA_current see Tweet)

This viewpoint suggests a more selective use of contact precautions for the control of endemic pathogens.


Viewpoint: Monitoring Medical Devices: Missed Warning Signs Within Existing Data – JAMA (free)

Related: The lap band for weight loss is a tale of medicine gone wrong – VOX (free) Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery – JAMA Surgery (link to abstract – $ for full-text) AND Safety, Effectiveness of Gastric Banding Called Into Question – Medscape (free registration required) AND 1 In 5 Gastric Band Surgeries Require Corrective Operations – American Council on Science and Health (free)

The authors use the example of gastric band surgery to discuss how available data may be used more appropriately for earlier detection of problems in the safety of medical devices.


Editorial: Natural health products should be sold separately from drugs – Canadian Medical Association Journal (free)

“Separate “natural” products from drugs to protect consumers, says @drstanbrook” (RT @CMAJ see Tweet)


Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis – Gastroenterology (free)

Source: EvidenceAlerts (free resource to find articles of interest)

In this meta-analysis including 19 randomized trials, probiotics given within 2 days of the first antibiotic dose (more effective than if started later) reduced the risk of Clostridium difficile infection (CDI) by >50% in hospitalized adults. 1 case of CDI would be prevented for every 23−144 patients treated with probiotics when antibiotics are started. “There was no convincing evidence of superior efficacy for any of the tested probiotic formulations, delivery methods (drink or capsule), or probiotic doses”.


Necessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities – Journal of Community Hospital Internal Medicine Perspectives (free) (RT @HMVJC see Tweet)

In this model of care, a hospitalist-led team, including the resident on the geriatrics rotation, followed patients discharged from the hospital to the skilled nursing facility, leading to significant decrease in readmission rates.


Benchmarking study helps hospitals improve measurement of adverse events – NIHR Signal (free)

Original report: Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study – Health Services and Delivery Research (free PDF)

This study compared two different approaches to measure adverse events, the “Trigger Tool system” and the “Two-stage review”


Value-Based Care Alone Won’t Reduce Health Spending and Improve Patient Outcomes – Harvard Business Review (a few articles per month are free) (RT @pash22 see Tweet)

“We believe that value-based care, implemented using lean principles and in conjunction with an ongoing, community-wide effort to address social determinants of health, can reduce health spending and deliver on the promise of better health”


Cardiopulmonary resuscitation – 30:2 or just keep going? – by Scott Munro, in Evidently Cochrane (free) (RT @NIHR_DC see Tweet)

“Untrained bystander CPR had better outcomes when given telephone advice from EMS services to perform continuous CPR, rather than interrupted CPR with rescue breaths”. For trained EMS professionals, “it is possible that there is little or no difference between the two approaches”.


Every Newborn Action Plan – World Health Organization (free) (RT @WHO see Tweet with infographic)

Related report from UK: Each Baby Counts – Royal College of Obstetricians and Gynaecologists (free PDF) Each Baby Counts Homepage (free resources) AND Reducing baby deaths and brain injuries during childbirth – BBC News (free)

Every year, 2.7 million babies die in the first 28 days of life. 75% of these deaths are preventable.


Performance Improvement: Phenytoin Toxicity – JAMA (free)

Interesting case of medication error and prevention of subsequent adverse events (RT @JAMA_current see Tweet)


Giles Maskell: The practice of radiology needs to change – The BMJ Opinion (free)

“The practice of radiology is unsafe and needs to change says, Giles Maskell” (RT see Tweet)


Lean: Targeted Therapy for Care Delivery –  Journal of the National Comprehensive Cancer Network (free)

The possible benefits of applying the “Lean” approach to oncology care delivery.


Surgeon Variation in Complications With Minimally Invasive and Open Colectomy: Results From the Michigan Surgical Quality Collaborative – JAMA Surgery (free) (RT @MaryDixonWoods see Tweet)

Surgeon-level variation in complications among surgeons was nearly twice as great for Minimally Invasive Colectomy than for Open Colectomy, implying a need for improved training in adoption of minimally invasive techniques.


Why overtreatment and overdiagnosis can be bad for your health – CBC Radio (free text and audio)

See more on the Choosing Wisely initiative in our April 5 issue, see #6.

“Choosing Wisely on CBC Sunday about overdiagnosis & importance of speaking with your doc about tests/treatments” (RT @ChooseWiselyCA see Tweet)


New Choosing Wisely List: American Society of Health-System Pharmacists – Five Things Physicians and Patients Should Question (free)

See more on the Choosing Wisely initiative in our April 5 issue, see #6.

“Great choosing wisely list from @ASHPOfficial. Great doctoring tips for physicians & trainees” (RT @AnilMakam see Tweet)


Non–Vitamin K Antagonist Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Renal Dysfunction – Journal of The American College of Cardiology (link to abstract – $ for full-text)

Commentary: NOAC Doses: Just Stick to the Label – MedPage Today (free registration required)

“Among the 1,473 patients with a renal indication for dose reduction, 43.0% were potentially overdosed, which was associated with a higher risk of major bleeding”


Association of Adverse Events With Antibiotic Use in Hospitalized Patients – JAMA Internal Medicine (link to abstract – $ for full-text)

Commentary: Antibiotic-Associated Adverse Events Common – Medscape (free registration required)

“20% of hospitalized patients receiving antibiotics had adverse drug event. Of those, 20% of regimens inappropriate” (RT @PeterPronovost see Tweet)


Leading Quality in Changing Times – NEJM Catalyst (free)

“4 principles for quality leaders in brave new world of population health” (RT @nejmcatalyst see Tweet)


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