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Description: Quality by Design offers a new and innovative approach to transforming our health care system to be safe, timely, effective, efficient, equitable, and patient–centered. The authors' microsystem concepts and proven approach achieve the best patient outcomes by developing reliable, efficient, and responsive systems that have the capability of(More)
BACKGROUND The transfer of care for hospitalized patients between inpatient physicians is routinely mediated through written and verbal communication or "sign-out". This study aims to describe how communication failures during this process can lead to patient harm. METHODS In interviews employing critical incident technique, first year resident physicians(More)
INTRODUCTION/AIM Standard curricula to teach Internal Medicine residents about quality assessment and improvement, important components of the Accreditation Council for Graduate Medical Education core competencies practiced-based learning and improvement (PBLI) and systems-based practice (SBP), have not been easily accessible. PROGRAM DESCRIPTION Using(More)
Tissue sample acquisition is a limiting step in many studies. There are many thousands of formalin-fixed, paraffin-embedded archival blocks collected around the world, but in contrast relatively few fresh frozen samples in tumour banks. Once samples are fixed in formalin, the RNA is degraded and traditional methods for gene expression profiling are not(More)
BACKGROUND Workarounds circumvent or temporarily 'fix' perceived workflow hindrances to meet a goal or to achieve it more readily. Behaviours fitting the definition of workarounds often include violations, deviations, problem solving, improvisations, procedural failures and shortcuts. Clinicians implement workarounds in response to the complexity of(More)
BACKGROUND There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. OBJECTIVE To improve training for residents who provide chronic illness care in teaching practice settings. DESIGN US teaching hospitals were invited(More)
BACKGROUND The Joint Commission has made a "standardized approach to hand-off communications" a National Patient Safety Goal. METHOD An interactive 90-minute workshop (hand-off clinic) was developed in 2005 to (1) develop a standardized process for the handoff, (2) create a checklist of critical patient content, and (3) plan for dissemination and(More)
The evaluation of organ weights in toxicology studies is an integral component in the assessment of pharmaceuticals, chemicals, and medical devices. The Society of Toxicologic Pathology (STP) has created recommendations for weighing organs in GLP general toxicology studies lasting from 7 days to 1 year. The STP recommends that liver, heart, kidneys, brain,(More)
BACKGROUND A lack of formal patient safety curricula has contributed to the suboptimal training of medical students and housestaff. Attitudes of physician trainees regarding medical errors and adverse events were surveyed in a pilot study. METHODS Five hundred sixty-three physician trainees were surveyed at an urban teaching hospital. Five domains were(More)
The microsystem is an organizing design construct in which social systems cut across traditional discipline boundaries. Because of its interdisciplinary focus, the clinical microsystem provides a conceptual and practical framework for simplifying complex organizations that deliver care. It also provides an important opportunity for organizational learning.(More)