Background: General wards are high-risk clinical areas, but frontline staff face operational challenges not prioritized in national safety initiatives. Team reporting may identify important risks to patient care, although its impact as a safety strategy is unknown. We developed HEADS-UP (Hospital Event Analysis Describing Significant Unanticipated Problems), a system for prospective clinical team surveillance (PCTS). [...]

Background: Diagnostic errors (DE), defined as missed opportunities to make a correct or timely diagnosis based on the available evidence, are a critical but understudied cause of patient harm. While previous efforts have focused on examining the incidence and factors contributing to DEs in ambulatory and emergency room settings, fewer studies have examined incidence of [...]

Background: Hospitalizations related to opioid use disorder (OUD) are rising, creating opportunities to initiate medications for opioid use disorder (MOUD) and connect patients with outpatient resources.1,2 Despite evidence that MOUD reduces morbidity and mortality, most patients fail to receive evidence-based treatment during hospitalization.3-6 Addiction consultation services are becoming the standard of care to address this [...]

Background: Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of single interventions. We sought to implement a set of complementary interventions and evaluate the effect on interprofessional teamwork and patient safety. Methods: The REdesigning SystEms to Improve Teamwork and [...]

Background: Diagnostic errors (DEs), or the failure to accurately identify or provide timely explanations of a patient’s health problem, are a significant source of patient harm. DEs occur in up to 23% of adult inpatients who transfer to intensive care units (ICU) or die. Few studies have examined how clinician team composition impacts DE risk. [...]

Background: General wards are high-risk clinical areas, but frontline staff face operational challenges not prioritized in national safety initiatives. Team reporting may identify important risks to patient care, although its impact as a safety strategy is unknown. We developed HEADS-UP (Hospital Event Analysis Describing Significant Unanticipated Problems), a system for prospective clinical team surveillance (PCTS). [...]

Background: Microaggressions (adapted from Sue et al. 2007) are “brief and commonplace verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults with regards to race, gender, religion, or sexual orientation that target a person or group”. In healthcare, studies have examined microaggressions’ effect on trainee experience, [...]

Background: Most academic general medical services cover patients across several different care units in the hospital. Studies have shown that de-regionalized care leads to a lack of team cohesion and poor communication between healthcare providers. Prior studies have shown that teamwork improves patient outcomes and increases health care worker satisfaction. However, little information using validated [...]

Background: One target for improvement of effective patient centered care on the inpatient medical ward is the mechanism for communication among the multidisciplinary care team (MCT).  The medical service at Stanford Hospital and Clinics recently implemented morning “team care rounds” (TCRs) that provided space for the MCT members, including the physician (MD), nurse (RN), case [...]

Background: Geographic localization of inpatient physician services to nursing units has been suggested to improve teamwork and patient safety among health care professionals, while perceived lack of collaboration has been associated with worse patient outcomes. On our inpatient oncology units, we previously found that large discrepancies exist in perceptions of teamwork and collaboration among professionals, [...]