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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}

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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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  • Funding JM research was supported by an AHRQ grant K08HS019767 from 2010 to 2015 and is currently supported by AHRQ grants P30HS024385 and R01HS018334 as well as funding from the VA National Center for Patient Safety and the Centers for Disease Prevention and Control. JM research has recently been supported by contracts with the Health Research and Education Trust (HRET) involving the prevention of CAUTI, funded by AHRQ and the Centers for Disease Prevention and Control, and the Centers for Medicare and Medicaid Services. JM was also a recipient of the 2009–2015 National Institutes of Health (NIH) Clinical Loan Repayment Program. JM is a salaried employee of the University of Michigan and the VA Ann Arbor Healthcare System.

  • Competing interests Honoraria:JM has reported receiving honoraria from hospitals and professional societies devoted to complication prevention for lectures and teaching related to prevention and value-based purchasing policies involving catheter-associated urinary tract infection and hospital-acquired pressure ulcers. Intellectual Property/Product Development: JM research involves development of products to improve patient safety by reducing hospital-acquired complications. Her team has a patent issued involving one of these products that aims to reduce urinary catheter associated complications and has recently applied for a patent involving a device to reduce hospital-acquired pressure ulcers. She has no associations with any companies or manufacturers, has no ownership in a commercial entity, and receives no royalties.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.