American journal of medical quality : the official journal of the American College of Medical Quality
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In spite of efforts to improve patient safety since the 1999 report, To Error Is Human, recent studies have shown limited progress toward preventing serious error. Most hospitals use root cause analysis as a method of serious event investigation. ⋯ This method resolves the 4 deficiencies noted above. The authors' experience investigating 105 serious events over 2 years is described.
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Patient safety indicators (PSIs) use inpatient administrative data to flag cases with potentially preventable adverse events (AEs) attributable to hospital care. This study explored how many AEs the PSIs identified in the 30 days post discharge. PSI software was run on Veterans Health Administration 2003-2007 administrative data for 10 recently validated PSIs. ⋯ The majority of postdischarge AEs were decubitus ulcers and postoperative pulmonary embolisms or deep vein thromboses. Extending PSI algorithms to the postdischarge period may provide a more complete picture of hospital quality. Future work should use chart review to validate postdischarge PSI events.
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As a safety net for the health care system, quality and safety performance in emergency medicine (EM) is important for policy makers, insurers, researchers, health care providers, and patients. Developing performance indicators that are relevant, valid, feasible, and easy to measure has proven difficult. ⋯ This article proposes a framework that measures safety through 4 major domains: (1) how often patients are harmed, (2) how often appropriate interventions are delivered, (3) how well errors in the system are identified and corrected, and (4) emergency department (ED) safety culture. Examples of specific measures for each of these domains are provided, but the EM community should reach consensus on what measures are important for the ED environment and patients.
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The relative contribution of long-term acute care hospital (LTACH) to short-term acute care hospital (STACH) Medicare patient readmissions is important because of the high acuity of LTACH patients. A retrospective cohort study was conducted to determine the magnitude of LTACH Medicare heart failure (HF) and pneumonia (PN) inpatient readmissions to STACHs within 30 days of LTACH admission and the relative contribution of LTACH patient readmissions to each STACH's total readmissions. ⋯ An average of 8% HF and 8% PN LTACH Medicare inpatients were readmitted to host or primary referral STACHs within 30 days of admission, representing 0.4% and 0.8% of the total number of HF and PN Medicare patients, respectively, readmitted to the STACHs in fiscal year 2010. The low rates of readmission from LTACHs to STACHs suggest an appropriate level of care for the LTACHs studied.