The effective transfer of patient care information is essential to a patient’s continuity of care whether conveyed in written documents, verbally, or electronically. Ineffective communication and transfer of patient information has been associated with medical errors, patient harm, and patient dissatisfaction.

It has been more than a decade since a major study at a 725-bed academic medical center found that 67% of 426 in-process intravenous (IV) infusions had one or more discrepancies, including potentially fatal errors such as heparin ordered for 1300 units/hour that was infusing at 200 units/hour, an amiodarone infusion ordered…

Infection control comes in many different packages these days. Critical care facilities have long noted the importance of hand hygiene and so have the various health standards and safety organizations. Indeed, “hand hygiene continues to be identified by the U.S. Centers for Disease Control and Prevention (CDC) as the single most important and basic intervention to reduce…

Three years ago, I traveled across the nation on a whirlwind tour that is the medical school interview process. Among all the facility walk-throughs, lunches with students, and the all-important interviews, one topic continued to show up like medical students at a free lunch: interdisciplinary education.

Workplace culture—employees’ attitudes toward each other and the work itself, as well as the mission and values of the organization—affects all aspects of performance, including safety for employees, customers, and the community.

Since the initial discovery of penicillin by Sir Alexander Fleming in 1928, a large number of antimicrobial agents have been harnessed for clinical use. While antimicrobial agents eradicate pathogens and control infections, it was recognized early on that bacteria exposed to antibiotics can evolve to survive them, raising concerns for antibiotic resistance.

Standing up in a canoe is hard enough. Standing up in two canoes with one foot in each while traveling through Class 4 rapids is mind-boggling. Class 4 rapids are defined as “intense, powerful, but predictable rapids requiring precise boat handling in turbulent water.”

Healthy People 20201 includes “Create social and physical environments that promote good health for all” as one of the four overarching goals for the decade. The program’s agenda includes social determinants of health as a new topic area.

I was recently asked by a care manager to “please educate the docs” on the difference between inpatient and observation. How many times in the daily work routine of a physician advisor have we heard that request or something similar?

New funding opportunities from AHRQ are dedicated to diagnostic safety.