2018 saw solid contributions to the literature on patient safety, with three papers demonstrating the importance of reflection and of sound evidence on which to base the design of interventions for improvement.

• Transforming concepts in patient safety: a progress report – in print, December 2018 issue. https://qualitysafety.bmj.com/content/27/12/1019

In this paper, members of the Lucian Leape Institute shared successes and ongoing challenges since their landmark analysis of the US healthcare system, chronicling the progress made and ongoing opportunities for improvement in five areas that had been identified in 2009 as requiring system-level attention and action to advance patient safety in US health systems. Examples of progress include improving house officer training in quality and safety, incentivizing better quality care through accountable care organizations, and the creation of patient and family advisory councils in many organizations. Ongoing opportunities to improve the health of patients and the health care workforce include reducing clinician burnout, incorporating patients as equal partners in their care support more consistently, and facilitating transparency within and across health care organizations.

• Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study – in print, August 2018 issue. https://qualitysafety.bmj.com/content/27/8/655

A novel study within the Emergency Department setting showed the effects of interruptions, multitasking, and fatigue on medication prescription errors within a busy clinical environment. Westbrook et al. followed 36 emergency physicians for a total of 120 hours to assess the effects of interruptions and multitasking on prescription errors. Overall, physicians were interrupted 7.9 times per hour of work, including 9.4 times per hour while writing prescriptions. Errors increased significantly with interruptions (RR 2.82), multitasking (RR 1.86), or when the physician had previously had below-average sleep (RR 16.44). These results suggest strategies to reduce interruptions and need for multitasking during critical activities may reduce safety events.

• Mortality of hospitalised internal medicine patients bedspaced to non-internal medicine inpatient units: retrospective cohort study – in print, January 2018 issue. https://qualitysafety.bmj.com/content/27/1/11

A study at a tertiary care institution suggested that the widespread practice of bedspacing or “outlying” patients to any available hospital beds rather than only those associated with the treating specialty may have implications for patient mortality. Bai et al. reviewed one year of general medicine admissions at a tertiary care facility in Canada to determine whether in-hospital mortality was associated with assignation to a general medicine ward as compared to off-service wards. Overall, 35% of general medicine patients were admitted to an off-service ward, with these bedspaced or “outlying” patients having approximately three times the risk of in-hospital mortality within the first week of admission. This work suggests multidisciplinary care may be at risk in units less familiar to treating clinicians, particularly in the vulnerable initial periods of hospitalizations.