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Quality and safety in the literature: September 2019
  1. Nathan Houchens1,2,
  2. Jennifer Meddings1,2,3,
  3. Ashwin Gupta1,2
  1. 1 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
  2. 2 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
  3. 3 Departmentof Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, United States
  1. Correspondence to Dr Nathan Houchens, Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States; nathanho{at}med.umich.edu

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Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

Key points

  • Increased flexibility in shift duration while maintaining a maximum weekly amount of duty hours for US internal medicine residents was non-inferior to standard duty-hour rules with regard to 30-day mortality, readmissions and various patient safety indicators. N Engl J Med. 7 Mar 2019

  • A significant amount of antibiotics prescribed for common acute indications in English primary care exceeded durations recommended by guidelines. This was especially true for respiratory tract indications and women with acute cystitis. BMJ. 27 Feb 2019

  • In a retrospective cohort study examining invasive diagnostic procedures to evaluate lung abnormalities, complication rates were more than two times higher than those found in a clinical trial. These complications were costly, varied depending on the procedure performed and patient age, and should be considered when approaching lung cancer screening. JAMA Intern Med. 14 Jan 2019

Patient safety outcomes under flexible and standard resident duty-hour rules

N Engl J Med. 7 March 2019

In 1984, 18-year-old Libby Zion died in a New York hospital as a result of a medical error while under the care of residents in a prolonged shift.1 Over the next two decades, her story, the resultant Bell commission,2 the burgeoning patient safety movement3 and an increased understanding of the effects of fatigue on clinical performance4 5 all catalysed increased scrutiny on duty hours, especially for physician trainees.

In 2003, the US Accreditation Council for Graduate Medical Education (ACGME) implemented new duty-hour regulations, standards establishing a maximum of …

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