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Quality & Safety in the Literature: January 2021
  1. Ashwin Gupta1,2,
  2. Nathan Houchens1,2
  1. 1 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2 Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Ashwin Gupta, Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; ashwing{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, while others will highlight unique publications from high-impact medical journals.

Key points

  • Schedules limiting resident physician work hours in paediatric intensive care units to no greater than 16 continuous hours resulted in increased adverse patient safety events as compared with schedules including shift durations of 24 hours. N Engl J Med. 25 June 2020.

  • A qualitative study identified numerous facilitators and barriers to integrating behavioural health into primary care and other outpatient clinics. Ann Intern Med. 2 June 2020.

  • A systematic review and meta-analysis demonstrated that clinical decision support systems produced an average absolute improvement of 5.8% in terms of the percentage of patients receiving the desired care process. BMJ. 7 August 2020.

Effect on patient safety of a resident physician schedule without 24-hour shifts

N Engl J Med. 25 June 2020

The 2011 decision by the US Accreditation Council for Graduate Medical Education to limit resident physicians to no greater than 16 consecutive hours of work1 has been the subject of immense controversy,2 and the impacts of these changes have been the subject of several studies published in the literature.3–6 Readers of Quality & Safety in the Literature may recall the September 2019 edition,7 in which we detailed this controversy and highlighted outcomes from the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education research group.5 In that and other recent studies,6 flexible duty hours (allowing for shift durations beyond 16 hours) were non-inferior to standard duty hours (restricted to fewer than 16 hours) in the outcomes of 30-day …

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  • Twitter @ashwin_b_gupta, @nate_houchens

  • Funding AG is supported by a grant funding from the Moore Foundation, the Society to Improve Diagnosis in Medicine and the Pepper Center.

  • Competing interests Both NH and AG are employees of the Veterans Affairs Healthcare System.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.