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Quality and safety in the literature: September 2020
  1. Nathan Houchens1,2,
  2. Ashwin Gupta1,2
  1. 1Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Nathan Houchens, Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; 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, while others will highlight unique publications from high-impact medical journals.

Key points

  • In a retrospective cohort study, patients with chronic life-limiting illness and pre-existing Physician Orders for Life-Sustaining Treatment (POLST) who were hospitalised near the end of their lives frequently received care that seemed incongruent with their documented preferences. Potential discordance occurred more frequently in those admitted with traumatic injury and less frequently in those with a history of cancer and dementia. JAMA. 16 Feb 2020.

  • In a cross-sectional study of US long-stay nursing home residents with advanced illness, rates of transfer to acute care hospitals for all causes and potentially avoidable conditions declined from 2011 to 2016 without an increase in mortality. JAMA Intern Med. 30 Dec 2019.

  • In a retrospective cohort study, researchers established and used novel metrics to characterise the utility and appropriateness of electronic consultations in a variety of medical specialties. These e-consults frequently resulted in avoided physician visits. Ann Intern Med. 19 May 2020.

Association of Physician Orders for Life-Sustaining Treatment with ICU admission among patients hospitalized near the end of life

JAMA. 16 Feb 2020.

Provision of care that honours a patient’s values, goals and wishes is the foundation of medicine. Goals of care conversations offer patients with chronic or life-limiting illness an opportunity to outline their wishes and expectations for medical care. It has been 30 years since the passage of the United States Patient Self Determination Act, which requires hospitals, skilled nursing facilities, home health agencies, hospice programmes and health maintenance organisations to inform patients of their rights to make decisions regarding their medical care, periodically …

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Footnotes

  • Twitter @nate_houchens

  • 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 None declared.

  • Patient consent for publication Not required.

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

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