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Quality and safety in the literature: July 2023
  1. Christie Youssef1,
  2. Nathan Houchens1,2,
  3. Ashwin Gupta1,2
  1. 1 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, 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, whereas others will highlight unique publications from high-impact medical journals.

Key points

  • Despite increased attention to patient safety over the last several decades, adverse events continue to be common in hospitalised patients, occurring in 23.6% of admissions studied. N Engl J Med, 12 Jan 2023.

  • Adjusted patient mortality was lower when hospitals achieved time-based process measure goals in the care of patients with ST-elevation myocardial infarction. JAMA, 22 Nov 2022.

  • In a qualitative study, physicians counselling patients on anticoagulation for atrial fibrillation often used language that emphasised risk of stroke and de-emphasised risk of bleeding, used emotion when reviewing specific medications, failed to adequately discuss medication costs, and used pharmaceutical television advertisements to educate patients. JAMA Intern Med, 1 Dec 2022.

The Safety of Inpatient Health Care

N Engl J Med, 12 Jan 2023

Literature evaluating adverse events in hospitals spans four decades. The Harvard Medical Practice Study, published in 1991, found an adverse event rate of 3.7 events per 100 inpatient admissions, of which 28% were attributed to negligence and 16% led to death or permanent disability.1 2 The Institute of Medicine’s 2000 report titled To Err is Human estimated that as many as 98 000 people die annually because of medical errors.3 Since publication of these findings, hospitals worldwide have taken measures to prevent adverse events. However, understanding the impact of these interventions remains elusive because accurate and timely data are often unavailable. For example, voluntary incident reporting systems are often used to capture adverse events, but result in undercounting. In one …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AG and NH are employed by the United States Department of Veterans Affairs.

  • Provenance and peer review Commissioned; internally peer reviewed.