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Quality and Safety in the Literature: July 2021
  1. Ryan Cooney1,
  2. Ashwin Gupta2,3,
  3. Nathan Houchens2,3
  1. 1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  3. 3Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Ryan Cooney, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA; rcooney{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 recently published in major medical journals. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

Key points

  • In a stepped-wedge cluster randomised clinical trial in older patients with acute heart failure, an emergency department care bundle that included guideline-based therapies and management of precipitating factors did not improve mortality nor important secondary clinical outcomes. JAMA. 17 November 2020.

  • The implementation of an electronic health record alert for acute kidney injury (AKI) influenced provider care practices but did not improve patient outcomes of mortality, need for dialysis or progression of AKI. Implementation of the alert appeared to increase the risk of death at two non-teaching hospitals. BMJ. 16 October 2020.

  • The use of a single composite measure was successful in producing valid, reliable and stable rankings of ambulatory care quality for a US healthcare system. Annals of Internal Medicine. 22 September 2020.

Effect of an emergency department care bundle on 30-day hospital discharge and survival among elderly patients with acute heart failure: the ELISABETH randomized clinical trial

JAMA. 17 November 2020

Heart failure is one of the most common clinical syndromes worldwide; it predominantly affects the elderly, who account for more than 80% of those affected.1 Older adults with heart failure often have both cardiac and non-cardiac comorbidities that make management difficult and adversely affect both morbidity and mortality. Notably, acute heart failure is the leading cause of hospitalisation in individuals over 65 years of age,1 and about a quarter of these patients are readmitted within 30 days of discharge.2 3 As the population has aged, this has led to a significant increase in health system costs. As a result, much quality improvement effort …

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  • Twitter @ashwin_b_gupta, @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 AG is supported by grant funding from the Moore Foundation, the Society to Improve Diagnosis in Medicine, and the Pepper Center. Both NH and AG are employees of the Veterans Affairs Healthcare System.

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