Collision avoidance is critical in external beam radiotherapy to ensure patient safety and plan deliverability. Limited understanding of the collision-free treatment space risks both patient safety and unnecessary exclusion of useful beams-particularly in noncoplanar setups-resulting in suboptimal plans. Conventional methods (manual clearance checks or CT-based assessments, etc.) are either labor-intensive or fail to account for collision-prone anatomy outside the scan. We investigated and clinically implemented a virtual patient-specific clearance mapping system and evaluated its utility as a noncoplanar beam selection tool to improve plan quality. The system integrates full-body, patient-specific surfaces-acquired during simulation using near-infrared imaging-with interactive 3D linac/couch models. Clearance mapping accuracy was validated through phantom measurements and a comparative analysis with manual clearance checks of 60 patients across treatment sites. Workflow efficiency data were reported over three years of clinical implementation. A workflow for patient-specific non coplanar beam selection was proposed and evaluated in 20 lung stereotactic body radiation therapy (SBRT) and 18 breast stereotactic partial breast irradiation (sPBI) cases. The clearance mapping accuracy was within±1° (gantry/couch rotation) of phantom measurements. For 60 patients, the virtual predictions accurately identified all potential clearance issues, while manual verification missed 5 collision events. Virtual checks saved approximately 15 min of linac and therapist time per plan and eliminated an average 6.2-clinical hour planning delay. With the proposed beam selection workflow, noncoplanar replans for lung SBRT improved target conformality (Paddick Conformity Index from 0.89 to 0.91, p<0.01) and reduced low dose spillage. For breast sPBI, heart mean dose was lowered (103 cGy to 68 cGy, p<0.01). Delivery time increased by approx. 30s per plan. The virtual clearance mapping system outperformed manual verification, streamlined clinical workflow, and could significantly improve plan quality through efficient noncoplanar beam selection. It has replaced manual verification at our institution.

Effective management and communication of diagnostic uncertainty are critical, yet understudied, drivers of patient safety in pediatric emergency care. We explored how clinicians manage and communicate diagnostic uncertainty and identified opportunities for intervention. Four 1-hour-long focus groups were conducted with 19 geographically diverse emergency medicine physicians. Discussions focused on clinical vignettes with diagnostic uncertainty. Reflexive thematic analysis was used to generate themes. Participants described diagnostic uncertainty as a multidimensional experience involving complex interactions between the clinician, caregiver, and context. We identified 3 distinct themes: (1) Intersection of clinician's usual practice pattern with caregiver and contextual factors: Within the guardrails of safety and evidence-based care, clinicians adjust management and communication to caregiver expectations, health literacy, resources, acuity, and volume. (2) Synergies at the clinician, caregiver, and context interfaces: Shared decision-making, decision support tools, and primary care continuity facilitate clinician-caregiver alignment and safety. (3) Tensions at the interfaces: Perceived misaligned clinician-caregiver expectations, space constraints, and limited access to care promote additional work-up and hinder communication. Participants highlighted intervention opportunities to promote patient safety in uncertainty and reduce ED work-up: (1) standard tools to communicate uncertainty, (2) disease-specific risk prediction models with visual aids to effectively communicate risk, (3) improvements to the physical space, and (4) interventions to streamline access to primary care. Diagnostic uncertainty in pediatric emergency care is a multidimensional experience influenced by synergies and tensions between the clinician, caregiver, and context. Communication tools, decision-support strategies, and systems-level interventions can strengthen diagnostic safety in pediatric emergency care.

This case report follows M.K., a 31-year-old man with spastic paraplegia who sustained a second-degree skin burn after his mobile phone charger cord was trapped beneath his back while hospitalized. This led to complications that necessitated three hospitalizations, multiple surgical interventions, and treatment for a hospital-acquired infection caused by multidrug-resistant bacteria. Nearly every patient brings a mobile phone (and, often, a charger) into the hospital, and the use of these and other electronic devices carries risks. Although numerous media and medical publications have reported serious and even fatal injuries caused by mobile phones and their chargers in domestic settings, reports of such incidents in hospitals remain scarce. This case study discusses the authors' experience in addressing various patient safety and risk management issues associated with patients' use of mobile phone chargers in a general hospital setting.

Carotid endarterectomy (CEA) has been considered the standard of care for symptomatic carotid stenosis (sCS). Carotid artery stenting (CAS) warrants reevaluation for equivalence to CEA given advances in embolic protection and stent technology. Our patients with sCS undergo computed tomography angiography and perfusion, magnetic resonance imaging, and carotid duplex ultrasonography to guide selection for CEA, CAS, or transcarotid artery revascularization (TCAR). Preoperative management includes dual antiplatelet therapy and maximal-dose statin therapy, comorbidity optimization, smoking cessation counseling, cardiac risk assessment for stroke, systemic anticoagulation for an intraluminal thrombus, and perfusion-based risk stratification. For CAS, we routinely use dual embolic protection with proximal balloon occlusion and distal filters, second-generation micromesh stents, and poststenting aspiration. Intravascular lithotripsy and integrated embolic protection have broadened the indications for CAS. We present our algorithm for managing sCS, demonstrating CEA, CAS, and TCAR as equivalent in safety and effectiveness for most patients, while recognizing select factors conferring higher risk with each approach.

Emergency Department (ED) crowding negatively impacts healthcare. Numerous strategies have been created to improve treatment of low-acuity conditions to reduce ED crowding and better utilize ED resources. We evaluated whether our novel "ED Surge" program within our institution's Care Transition Clinic (CTC), which triages patients with lower-acuity conditions from the ED to our same-day on-site ambulatory CTC, impacted future ED and hospital utilization. Demographics, visit characteristics, and clinical outcomes were evaluated. Bivariate and multivariate analyses assessed associations between patient, visit, and outcome characteristics. Significance was defined as p<0.05. The ED Surge program saw 727 unique patients and 762 scheduled visits with 76% completion across 31 months of operation. Patients were significantly younger (p<0.01) and insured with Medicaid (p<0.01) than the general ED population. This population also experienced a significant decrease in 30-day post-appointment ED utilization (0.08 post-versus 0.2 pre-mean visits, p=0.01) than those who did not complete an appointment. We also identified several diagnoses that may be better served in the ED as opposed to the ambulatory setting. Innovative clinics such as our "ED Surge" program held within ambulatory care sites such as the CTC can be a useful tool to impact future ED utilization of patients with low-acuity conditions. Care should be taken to design the clinic to an ED's specific population needs (such as underserved patient groups) and refine it according to how the clinic's patient outcomes develop to optimize patient care and safety.

Patient's perspectives about the immediate online access of bronchoscopy biopsy results through a patient portal.

Hip fractures are a significant public health concern, associated with substantial morbidity and mortality. Mortality is the most serious consequence of hip fractures, with a 1-year rate ranging from 14% to 36%. Hospital harms are also more prevalent among older adults with hip fractures, further increasing their risk of mortality. This study aimed to assess the incremental risk of all-cause mortality up to one-year post-discharge among hip fracture patients who experienced hospital harm. A population-based retrospective cohort study using linked health administrative data in Ontario, Canada, was conducted. The cohort included individuals aged 50 years and older hospitalized for hip fractures between April 2008 and March 2022 and discharged alive. All-cause mortality within one-year post-discharge was the primary outcome, and hospital harm was the main exposure. We used Cox proportional hazards models to assess the association between hospital harm and mortality, adjusting for covariates (e.g., age, sex, comorbidities, frailty, and surgery status). A total of 131,472 patients admitted for acute hip fractures and discharged alive were included in the study, with a mean age of 80.67 ± 10.56 years. Of these patients, 17.5% experienced hospital harm during their admission for an acute hip fracture. The overall mortality rate was 18.4% within 1-year post-discharge. After adjusting for covariates, patients who experienced overall harm had a 42% higher risk of all-cause mortality during the 1-year period post-discharge (adjusted hazard ratio, aHR = 1.42, 95% confidence interval, CI: 1.38-1.46) compared to those without harm. Experiencing hospital harm significantly increased the risk of 1-year mortality after discharge among hip fracture patients. These findings underscore the importance of improving patient safety and minimizing preventable harm in hospital settings. Mitigation strategies, such as enhanced monitoring and safety protocols, could reduce hospital harm and improve long-term survival. Future research should focus on evaluating such interventions.

Packed red blood cells (PRBC) are indispensable but high-risk therapeutic agents with a high quality of preparation but the safety of administration is compromised by avoidable errors. The physician's decision for a transfusion must consider both the inherent risk profile of the high-quality product and the safety of administration. Key problem areas in the clinical use of PRBCs include confusion of products and hemolytic transfusion reactions due to process or identification errors, undertransfusion resulting from logistical bottlenecks or misjudgement and overtransfusion due to the overreliance on hemoglobin concentrations as transfusion trigger and alack of adherence to guidelines. The risk of PRBC overdosing, in particular, is currently underestimated. As alarge proportion of adverse events are application-related and therefore potentially preventable, technical safeguards, digitalization, structured processes and consistent patient blood management are essential measures for increasing patient safety.

Nursing home residents and health care personnel (HCP) are at increased risk for exposure to influenza; in addition, residents of nursing homes who acquire influenza are at increased risk for severe disease. The Advisory Committee on Immunization Practices recommends routine annual seasonal influenza vaccination for persons without contraindications, including HCP and those at increased risk for severe influenza. Nursing homes report influenza vaccination among residents and HCP to CDC's National Healthcare Safety Network. This report describes influenza vaccination coverage among nursing home residents and HCP working in nursing homes during the 2024-25 influenza season (October 1, 2024-March 31, 2025). At the end of the 2024-25 influenza season, influenza vaccination coverage was 61.3% among nursing home residents and 42.1% among HCP who work in nursing homes; coverage among HCP varied by employment type. This study is the first comprehensive, national assessment of influenza vaccination coverage among nursing home residents and HCP who work in nursing homes in the United States. Monitoring of influenza vaccination coverage in this population at high risk for influenza exposure and severe influenza disease, along with implementation of a combination of influenza vaccination, administration of influenza antiviral medications, and other recommended practices to control the spread and severity of influenza in nursing home settings, can help protect nursing home residents and HCP against severe influenza-associated outcomes.

Accreditation programs are used by hospitals and health services to be independently reviewed against established safety and quality standards and have been a feature of global health systems for over a century. While evidence that accreditation programs directly improve patient safety and quality outcomes exists, the findings of various researchers remain mixed. Inefficiencies and a culture of "gaming" the system have also been observed, raising questions about the overall effectiveness of accreditation programs and assessment processes. Consequently, exploration of other formats of accreditation assessment, such as short-notice accreditation assessment, has arisen. From July 1, 2023, the Australian Commission on Safety and Quality in Healthcare mandated that Australian public and private hospitals must engage in short-notice accreditation assessment. This study aims to explore the impact of short-notice accreditation assessment on hospitals, both in terms of safety and quality indicators, and organizational culture. A mixed methods design will be used to investigate these impacts. Quantitative safety and quality indicators will be drawn from a regional health service prior to and following its first short-notice accreditation assessment cycle. From the same site, staff will be invited to complete the Patient Safety Culture Survey and participate in semistructured interviews. Using Schein's Culture Framework as an organizational culture model, the study will examine observable outcomes (artifacts, behaviors, and indicators) alongside staff perceptions and experiences (norms and values) to form an understanding of underlying assumptions and beliefs about short-notice accreditation assessment processes. Quantitative data will be analyzed through cross-tabulation, trend analysis, and other statistical techniques, while qualitative data will be synthesized to provide a comprehensive understanding. This protocol outlines the planned evaluation of short-notice accreditation assessment and its influence on patient safety and quality culture within a regional health service. Data collection is underway, with preintervention surveys being completed, and recruitment open for postintervention interviews. The study is expected to generate new knowledge on how this accreditation assessment process affects patient safety and quality culture of a regional and a rural hospital. The findings will inform health policy on the suitability and long-term viability of short-notice accreditation assessment as an approach to ensuring safe, high-quality health care.

Clinical response to mycophenolic acid (MPA) is highly heterogeneous; thus, therapeutic drug level monitoring (TDM) may help improve treatment efficacy. This systematic review and meta-analysis examined therapeutic ranges for MPA levels associated with better outcomes and safety in patients with systemic lupus erythematosus (SLE), particularly those with extrarenal manifestations. We performed a comprehensive search of studies evaluating associations between MPA levels and clinical SLE response. Using forest plots, we calculated pooled odds of clinical response by MPA levels and measured the weighted mean differences across outcomes. Analysis was performed in all patients with SLE and separately in patients with extrarenal manifestations. Among 459 reviewed abstracts, 24 met inclusion. Summarized evidence supported that clinical response was observed at MPA area under the curve at 0 to 12 hours (AUC0-12) ≥30 to 35 mg hr/L or trough concentration (Ctrough) ≥1.5 mg/L. At these thresholds, therapeutic MPA levels were associated with 12-fold higher odds (95% confidence interval [CI] 5.44-27.35; P < 0.0001; I2=41%) of overall clinical SLE response and 15-fold higher odds (95% CI 4.74-46.89; P < 0.0001; I2=61%) of response in patients with extrarenal manifestations. Additionally, MPA levels were 32 units higher (95% CIs 17.35-45.67) in overall responders with SLE and 39 units (95% CI 15.05-62.53) higher in patients with extrarenal manifestations. Although pooled analysis did not show a significant increase in adverse events, individual studies suggested safety concerns at MPA AUC0-12 >60 mg hr/L or Ctrough ≥2.5 to 3 mg/L CONCLUSION: This study highlights the clinical utility of TDM to guide MPA dosing to balance efficacy versus safety in all patients with SLE, including those with extrarenal manifestations.

Research and innovation are essential for advancing clinical practice and safeguarding patient safety in healthcare. This review aims to assess the research capacity of Advanced Practice Nurses in Australian healthcare settings. By identifying the barriers and enablers to, the findings aim to inspire research engagement of paediatric nurses. A rapid review methodology was used to systematically identify, appraise and synthesise data relevant to Advanced Practice Nurses' research capacity. A comprehensive search of Ovid Medline and Cumulative Index to Nursing and Allied Health Literature databases was conducted, covering publications from 1 July 2010 to May 2024. Additional reference checks and grey literature searches were undertaken to identify relevant studies. Data extraction and quality appraisal were conducted independently and checked by the research team. The Mixed Methods Appraisal Tool was used for quality assessment and a descriptive narrative synthesis approach integrated findings across qualitative, quantitative, and mixed methods studies. Eight studies met the inclusion criteria. Findings revealed that while Advanced Practice Nurses value research and evidence-based practice, barriers-such as time constraints, limited resources, and lack of organisational support-restricted their engagement. Leadership support and structured mentorship were identified as critical enablers of research capacity. This review highlights the need for targeted strategies to enhance Advanced Practice Nurses' research capacity within Australian healthcare. Addressing identified barriers and fostering a supportive environment can empower Advanced Practice Nurses to better utilise their roles, contributing to improved patient care and healthcare innovation. This research addresses the limited understanding of research capacity among Advanced Practice Nurses identifying challenges and opportunities for engagement. It is particularly relevant for healthcare organisations, policymakers, and educational institutions seeking to strengthen research capacity among APN roles. Findings will inform evidence-based practice, patient outcomes, and research culture in Australian healthcare services. International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42024539163.

Medication errors in hospital pharmacies are still a major source of patient injury and healthcare expenditure globally. There has been a growing trend of implementing pharmacy automation technologies to improve the efficiency of work processes and minimise errors. However, there is a lack of evidence on the cost-effectiveness of these technologies. The objective of this systematic review was to assess the cost-effectiveness of pharmacy automation technologies such as automated dispensing cabinets (ADCs), robotic dispensing systems, automated compounding systems, barcode-assisted medication administration (BCMA) and unit-dose dispensing systems (UDDS) compared with traditional manual dispensing systems in inpatient and outpatient hospital pharmacy settings. Literature searches were performed using PubMed, Scopus, ScienceDirect and Google Scholar on 11 January 2026. The search terms were developed using Boolean operators and key words for pharmacy automation and economic evaluation. Articles were independently screened by two authors using Covidence software and any disagreements were resolved by consensus. The articles were selected based on predefined inclusion and exclusion criteria, focusing on cost-effectiveness outcomes in hospital pharmacy settings. The findings were qualitatively synthesised. A total of 613 articles were screened for title and abstract, and 7 of 118 full-text articles were selected based on the inclusion criteria. The included articles assessed various automation technologies such as ADCs, robots, UDDS, BCMA and LED-guided picking systems in hospital settings in Taiwan, Germany, the Netherlands, Singapore, Denmark and Brazil. Cost-effectiveness analysis showed large error reduction rates, with incremental cost-effectiveness ratios ranging from €2.01 to €386 per error prevented, and large efficiency gains, including time savings of up to 25.68 min per patient and equivalent to 11.7 full-time equivalent nurses. Automation reduced clinical, procedural and potentially harmful errors in comparison to manual systems, thereby supporting better patient safety and efficiency. Pharmacy automation technologies are highly cost-effective and efficient compared with manual dispensing systems. These technologies reduce errors, improve efficiency and can also provide cost savings, thereby providing rationale for their use as a strategy for optimising hospital pharmacy operations.

Nurses have a key role in prevention of Surgical Site Infections (SSIs) through provision of evidence-based care and ensuring patient safety; despite this, existing studies indicate unsatisfactory standards of nursing practice. This is further aggravated by low awareness, implementation and adherence to SSI prevention guidelines across various health care settings globally. In Kenya, the burden of SSIs was estimated at between 20% to 30% affecting patient safety, cost of surgical treatment, duration of hospitalization and mortality in severe cases. Mbagathi and Mama Lucy hospitals are major referral facilities in Nairobi County facing a similar burden of SSIs. The two hospitals had inconsistent standards of nursing practice in prevention of SSIs compromising the quality of surgical care. This was a pre-test post-test nonequivalent groups quasi-experimental study design that was conducted over a duration of 9 months. The study intervention was utilization of the world health organization SSI prevention guidelines by nurses working at Mbagathi hospital while the control was ongoing routine care at Mama Lucy hospital. The primary outcome variable was nursing practice in prevention of SSIs. The study involved a total of 126 nurses with a sample size of 63 participants from each of the hospitals. The ethical approval reference was NACOSTI/P/24/35347. Informed consent for participants ensured before data collection. Simple random sampling was used and data collected through questionnaires and observation checklists. Data was analysed using chi square and fishers test to compare practice between the two hospitals. Mann-Whitney U test was used to evaluate the effect of the intervention and control on the overall nursing practice. Implementation of the SSI care guidelines checklist led to improved nursing practice in prevention of SSIs compared to routine care (p=0.0041). The SSI care bundle checklist is therefore recommended for implementation to improve the quality and safety of surgical care.

The Veterans Health Administration (VHA) aims to improve patient safety by becoming a high reliability organization (HRO), which requires a culture of continuous quality improvement (CQI). Despite national HRO emphasis, conditions supporting or hindering frontline staff engagement in CQI efforts, especially skill development, are not well understood. We conducted semistructured interviews at VHA sites participating in one of 3 randomized trials to improve clinical outcomes by engaging staff in quality improvement (QI). We conducted interviews with primary care and mental health staff and leaders to assess local context, including barriers and facilitators to engaging in QI training and initiatives. Interviews were coded using the updated Consolidated Framework for Implementation Research and analyzed for cross-cutting themes. Analysis of 56 interviews revealed that despite high-level leadership support for HRO principles, including patient safety, most sites lacked adequate infrastructure and leadership engagement necessary to support participation in QI training and projects. Barriers included limited time, unclear direction, burnout, and lingering COVID-19 pandemic effects. These challenges often prevented staff from developing foundational QI skills critical for entering a positive feedback loop of engagement and empowerment. Opportunities for improvement varied based on leadership style, team cohesion, role clarity, and location. To advance as HROs, health systems must go beyond high-level endorsement and invest in skill development and provide protected time to enable local leaders and frontline providers to do QI. Future work should explore how leaders can create sustainable conditions for improvement efforts and better align system-level goals with local realities.

Artificial intelligence (AI) is rapidly evolving worldwide, enabling greater flexibility and applicability to the field of language translation within healthcare. Australia is currently one of the most culturally and linguistically diverse countries in the world, creating a growing pressure on translators to ensure there is equitable and culturally safe access to healthcare services. Emerging research supports the use of AI as an adjunct to the current translator framework in being able to support low-risk communication tasks, such as appointment coordination or simple instructions, but it should be avoided in high-stakes contexts including informed consent or complex management discussions. Importantly, human oversight is needed to ensure clinical accuracy and patient safety during all translations.

In relapsing-remitting multiple sclerosis (RRMS), conventional immunomodulatory and immunosuppressive therapies are widely used. However, in many cases, optimal control of inflammatory activity and disease progression is not achieved, which has led to the use of biological drugs such as monoclonal antibodies that act specifically on key components of the immune system. The aim was to evaluate the efficacy and safety of monoclonal antibodies compared to other drugs or placebo in adult patients with RRMS. A systematic review was performed based on randomized, double-blind, phase III controlled clinical trials published between 2012 and 2025 in the PubMed, Cochrane Library, and Web of Science databases, assessing efficacy and safety in adult patients with RRMS. The review was carried out following the PICO methodology and PRISMA guidelines. A total of 11 studies were included, evaluating 5 monoclonal antibodies: alemtuzumab, daclizumab, ocrelizumab, ofatumumab, and ublituximab. These therapies showed superior efficacy compared to conventional treatments in reducing the annual relapse rate, MRI inflammatory activity and MRI activity, particularly in patients with highly active disease. However, effects on disability progression were heterogeneous across trials and not consistently significant. In addition, decreases in biomarkers of axonal damage were observed. Nevertheless, relevant adverse effects were identified, including infections, autoimmune reactions, hepatic and cutaneous toxicity, whose incidence varies depending on the drug, requiring close clinical monitoring. Monoclonal antibodies are an effective option in RRMS, with clinical and radiological benefits superior to those of conventional treatments. Their use requires individualized assessment and close follow-up due to the risk of adverse effects, especially in high-risk patients.

Accurate preprocedural planning is crucial for a successful transcatheter aortic valve implantation to ensure patient safety and valve longevity. Through 3-dimensional visualization, virtual reality (VR) offers the potential to enhance this process. The study investigated whether the inclusion of VR in preprocedural planning can improve the procedural preparation, impact intraprocedural parameters, and improve short-term patient outcomes. This randomized, prospective, controlled study included 140 patients who underwent transcatheter aortic valve implantation at the University Hospital Duesseldorf between April and August 2024. In the control group, preprocedural planning was based on multislice computed tomography data using 3mensio software, while in the intervention group, it was supplemented with VR software. In addition, interventionalists assessed both tools via a structured questionnaire. The evaluation did not reveal any relevant differences in patient characteristics. VR was superior to 3mensio software with respect to the 3-dimensional understanding (P<0.001). Similarly, depth perception, visualization of atherosclerotic plaques, and iliofemoral tortuosity were better in the VR group. Both methods were found to be useful and helpful in preparing for the procedure. There were no significant differences in procedural data between the 2 groups. However, the VR group had a lower rate of bleeding at the access site (P<0.05). There was no significant difference in the length of hospital stay or postprocedural transthoracic echocardiography data evaluations. The data show that virtual reality visualization can optimize preparation for the procedure by improving the 3-dimensional understanding of the aortic valve and adjacent structures. The detailed visualization of the access routes can lead to a reduction in periprocedural complications.

The increase in older adults and active lifestyles has made chondral and osteochondral lesions common in the population, making them one of the central challenges in orthopedics. Although hydrogel-based regenerative medicine offers an encouraging therapeutic option for these lesions, important obstacles still prevent these therapies from reaching the clinic. In view of these factors, we adopted a risk-based approach for this review, in line with the current legislative requirements in clinical translation and clinical trials. We identified the factors that could undermine patient safety or lead to poor outcomes. Then, we outlined solutions to remedy these problems that integrate hydrogel technology, clinical/pharmaceutical/surgical protocols, and post-operative follow-up. Upcoming studies should give priority to the development of hydrogel scaffolds modified to mimic cartilage’s mechanical and physicochemical properties, together with patient-specific features. Other crucial characteristics are host-tissue integration, long-lasting cartilage tissue regeneration, and a positive outcome. In parallel, to scale complex and costly innovations, efforts should focus on a harmonized, simplified legislative landscape, optimized standards, and established follow-up protocols. Getting through this “valley of death” between research and innovation is strategic for reaching the clinics and the largest number of patients.

Effectiveness of mixed reality-based intubation nursing simulation: A randomized controlled trial.