Patients and clinicians alike need to be able to rely on a consistent, objective, and fair review of the case.

A document to assist institutions in reviewing policies, procedures and forms relative to obtaining and documenting informed consent.

A 59-year-old female whose last name matched another Emergency Department patient had an acute hemolytic reaction after she received the incorrect blood type.

A 53-year-old male died intraoperatively during an elective total knee replacement after suffering a cardio-pulmonary arrest.

A young adult with a history of IV drug use became paraplegic after repeated Emergency Department (ED) visits for a complaint of back pain.

Insights April 2023

Patient Safety Alert Issue 31: The AMC PSO convened for a review of the care of critically ill patients who are boarded in the Emergency Department. Experts recommended ways to recognize patient safety risks and employ mitigation strategies associated with extended boarding of patients awaiting an intensive care unit (ICU) bed.

A 68-year-old male suffered from septic shock after being discharged from an inpatient setting before any action was taken on a critical lab result.

Patients frequently experience a delayed diagnosis due to a lack of follow-up. Preventing these gaps in communication is what hospitals are trying to mitigate through the implementation of ambulatory safety nets.