JAMA Performance Improvement: Do No Harm

Violence against health care workers is increasing. With fewer mental health services available, health care workers have disproportionate exposure to potentially dangerous patients. This article reviews the experience of one nurse who was severely injured by a patient and the lessons learned by the hospital where the incident occurred regarding minimizing the risk of staff injury when providing care for potentially violent patients. We interview Robert P. Roca, MD, MPH, MBA; Antonio DePaolo, PhD; Ernestine Cosby, RN; and Bolarin Kehinde, RN, to shed light on this serious issue.

Article discussed in this episode: Ensuring Staff Safety When Treating Potentially Violent Patients

There are about 500 wrong-site surgeries performed in the United States every year. Simple maneuvers can minimize the risk for these occurring. This JAMA Performance Improvement podcast reviews a case of wrong-site surgery and discusses potential ways to avoid it.

Interviewees include Armando Giuliano, MD, Harry Sax, MD, Kathryn Englehart, MD, and David Baker, MD, from The Joint Commission.

Read the article: Wrong-Site Surgery

Author Affiliations:

Armando Giuliano, MD, Executive Vice Chairman, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles

Harry C. Sax, MD, Executive Vice Chair, Administration Department of Surgery, Cedars-Sinai Medical Center, Los Angeles

Kathryn Englehart, MD, Research Fellow, Department of Surgery, Northwestern University

David Baker, MD, Executive Vice President, Division of Health Care Quality Evaluation, The Joint Commission

Electronic health records are the bane of most clinicians’ existence. They were supposed to help us but not only have they made life more difficult for clinicians, they are the cause of medical errors. Described here is a case of the patient receiving an unnecessary procedure because an order was not canceled in an EHR where it had disappeared from the clinicians’ view. A second theme in this case that is consistent in nearly all of the JAMA Performance Improvement articles to date is inadequate communication among clinicians.

As physicians age, they experience the inevitable decline of cognitive and physical function. It is not clear how that affects clinical practice. Jeffrey Saver, MD, vice chair of neurology at UCLA and a JAMA Associate Editor, discusses how to best assess the clinical performance of aging physicians.

The Aging Clinician: When Should Older Clinicians' Cognitive Abilities Be Evaluated?, Part 1

Read the article:

Cognitive Testing of Older Clinicians Prior to Recredentialing

There are hundreds of thousands of liver transplant patients, all of whom will be seen in general clinical practices. It is common for them to develop elevated liver enzymes—a potentially serious problem that may be a sign that the transplanted liver is failing. Traditionally, patients with these findings are sent to a liver transplant center for an inpatient workup. A new protocol facilitating management of most of these patients in routine outpatient clinics has been developed, greatly improving the efficiency of managing patients with this clinical problem. Fady Kaldas, MD, director of the Dumont-UCLA transplant center, discusses how to manage elevated liver function results in liver transplant patients on an outpatient basis.

Related Article(s):

Outpatient Management of Liver Function Test Abnormalities in Patients With a Liver Transplant