Articles TEST 1

Question 1

What reimbursement system creates incentives for early hospital discharge?

Answer 1

The prospective payment system, which pays a flat rate per diagnosis.

Question 2

How do bundled payments incentivize hospitals and postacute facilities?

Answer 2

They share a single payment for an episode of care, encouraging collaboration to prevent readmissions.

Question 3

What does the hospital readmission reduction program do?

Answer 3

Penalizes hospitals with high readmission rates, creating incentives for better discharge planning.

Question 4

What is one major cause of unsafe postacute transitions?

Answer 4

Financial incentives that encourage early discharge without adequate planning.

Question 5

What are the take-home points from this case?

Answer 5

1. Transitions to postacute care pose safety risks.
2. Failure to optimize timing and facility type contributes to harm.
3. The CARE Item Set and payment reforms aim to improve safety and coordination.

Question 6

What is a medical liability or malpractice claim?

Answer 6

A civil claim a patient may pursue against physicians or healthcare providers if injury or death occurs due to a negligent act or omission.

Question 7

What must a patient establish to recover damages in a malpractice claim?

Answer 7

1. The physician owed a duty to the patient.
2. The standard of care and that it was violated.
3. A compensable injury occurred.
4. The violation caused the harm suffered by the patient.

Question 8

What are examples of economic damages?

Answer 8

Medical care costs, hospital bills, rehabilitation, custodial care, lost wages, and future earning loss.

Question 9

What are noneconomic damages?

Answer 9

Compensation for subjective, non-monetary losses such as pain and suffering, mental anguish, disfigurement, or loss of enjoyment of life.

Question 10

What are compensatory damages?

Answer 10

The total of economic plus noneconomic damages awarded to compensate the patient for their losses.

Question 11

What are punitive damages?

Answer 11

Also called exemplary damages, they are awarded to punish egregious conduct and deter future wrongdoing, not to compensate the patient.

Question 12

What are ‘I’m sorry’ laws?

Answer 12

Laws that make apologies or expressions of sympathy by medical professionals inadmissible as evidence of fault in malpractice cases.

Question 13

What do ‘I’m sorry’ laws generally protect?

Answer 13

Statements of sympathy, condolences, or apologies made by healthcare providers after an adverse event.

Question 14

What are the four components of an apology described by Aaron Lazare?

Answer 14

Acknowledgment, Explanation, Expression of remorse and humility, and Reparation.

Question 15

Who is the most appropriate person to deliver the apology?

Answer 15

The clinician directly responsible for the patient’s care.

Question 16

What are the take-home points from this sepsis case?

Answer 16

1. Pelvic radiation increases perforation risk.
2. Nonoperative management needs close follow-up.
3. Effective transitions reduce readmissions.
4. Bundled post-discharge care improves outcomes.
5. Direct inter-specialty communication is essential.

Question 17

What is the estimated number of annual deaths from medical errors in hospitals?

Answer 17

As many as 98,000 people per year.

Question 18

What are the three main areas where the IOM made recommendations for improving safety?

Answer 18

1. Leadership,
2. Improved data collection and analysis,
3. Development of effective systems at the level of direct patient care.

Question 19

What are some of the key strategies proposed for improving patient safety?

Answer 19

Stronger leadership, better data systems, safety-focused regulation, and fostering a non-punitive culture.

Question 20

What type of initiatives does the report promote to prevent errors?

Answer 20

System-level interventions such as safety checklists, standardized protocols, and error reporting systems.

Question 21

What percentage of preventable hospital errors are diagnostic according to the Harvard Medical Practice Study?

Answer 21

17% of preventable errors in hospitalized patients were due to diagnostic error.

Question 22

What percentage of patients in autopsy studies experienced major undetected diagnostic errors?

Answer 22

Approximately 9% of patients had major diagnostic errors undetected during life.

Question 23

What are heuristics in clinical decision-making?

Answer 23

Mental shortcuts or ‘rules of thumb’ clinicians use to make quick diagnostic judgments.

Question 24

What is the availability heuristic?

Answer 24

Diagnosis biased by recent or memorable past cases.
Example: Treating chest pain as MI instead of aortic dissection due to past MI cases.

Question 25

What is the anchoring heuristic (premature closure)?

Answer 25

Relying on initial impressions despite new information. Example: Dismissing repeated positive cultures as contaminants despite infection.

Question 26

What is one challenge in improving diagnostic safety measurement?

Answer 26

Current quality metrics do not account for diagnostic accuracy—organizations can score well despite diagnostic errors.

Question 27

What is a 'never event'?

Answer 27

A serious, preventable adverse event such as wrong-site surgery or wrong-patient procedure.

Question 28

What is a 'sentinel event'?

Answer 28

A patient safety event resulting in death, severe or permanent harm, not related to the natural course of illness.

Question 29

Define a healthcare 'microsystem'.

Answer 29

A small unit (team/area) with shared aims/processes that delivers daily care and outcomes/ Core Aim: Build small, replicable systems for efficient, excellent, patient-centered care.

Question 30

What is PDSA?

Answer 30

Plan-Do-Study-Act: a cyclical, continuous improvement method.

Question 31

What does 'Identify Patients Correctly' mean?

Answer 31

Use at least two identifiers (like name and date of birth) before giving care, medications, or blood to prevent mix-ups.

Question 32

What does 'Improve Staff Communication' require?

Answer 32

Ensure critical test results reach the right staff member promptly to prevent delays in treatment.

Question 33

What do the medication safety goals address?

Answer 33

Label all medications, take extra care with high-risk drugs, and reconcile medications at each transition to prevent drug errors.

Question 34

What does 'Prevent Infection' require?

Answer 34

Follow CDC or WHO hand hygiene guidelines and sterile techniques to reduce hospital-acquired infections.

Question 35

What does 'Prevent Patient Harm from Falls' involve?

Answer 35

Identify patients at risk for falling and take steps like bed alarms or assistive devices to prevent injuries.

Question 36

What does 'Prevent Pressure Injuries' mean?

Answer 36

Assess patients for skin breakdown risk and use repositioning and padding to prevent bedsores.

Question 37

What does 'Perform Surgery Safely' include?

Answer 37

Use a 'time-out' before surgery to confirm correct patient, site, and procedure, preventing wrong-site or wrong-person errors.

Question 38

What does 'Identify and Reduce Suicide Risk' focus on?

Answer 38

Screen patients for suicide risk and create safety plans to prevent self-harm or suicide.

Question 39

What does 'Ensure Home Safety' involve?

Answer 39

Identify home hazards, like oxygen fire risks, to ensure patient safety in home care settings.

Question 40

What does 'Advance Health Equity' promote?

Answer 40

Identify and address disparities in care to improve health outcomes and ensure fairness for all patients.