UP FRONT

Research continues to show that providing patients with access to clinical notes of ambulatory care visits — “open notes” — can improve patient safety and may offer opportunities to reduce disparities in health care.

In one study, more than 23,000 patients were asked if they had seen errors in their clinical notes. About one-in-five of the respondents said yes and considered nearly half of the errors to be serious. And in new analysis, researchers suggest that patients with limited education or English proficiency benefit from sharing open notes with friends and family members for help with translation and understanding, as well being able to review the information on their own time.

Sigall Bell, M.D., who leads the OpenNotes Patient Safety Initiative that sponsored these and other studies of shared visit notes, says, “These findings support greater efforts to engage all patients in health information access.”


 Six internationally-recognized patient safety research and improvement experts, including Don Berwick, Charles Vincent and René Amalberti, offer a 5-step plan for leveraging quality improvement and patient safety teams to boost organizations’ ability to respond and retool in the rapidly-changing patient care environment brought on by the pandemic.

  1. Strengthen the system by assessing readiness, gathering evidence, setting up training, promoting staff safety and bolstering peer support.
  2. Engage with citizens, patients and their families so that the solutions are jointly achieved and owned by both the providers and the people who receive care and in particular the citizens who are required to undertake preventive interventions.
  3. Work to improve care through actions such as the separation of flows, flash workshops on teamwork and the development of clinical decision support.
  4. Reduce harm by proactively managing risk to both COVID-19 and non-COVID-19 patients.
  5. Boost and expand the learning system to capture improvement opportunities, adjust very rapidly and develop resilience.

A new resource, Person-Centered Guidelines for Preserving Family Presence in Challenging Times , offers a set of principles and guidelines to help health care settings navigate the twin goals of honoring person-centered care and minimizing the risk of coronavirus spread within health care settings and the broader community.

Crafted by a multi-stakeholder “pop-up” of patients, advocates, clinicians, infection control experts, health care executives, and policymakers, the 10-page publication from Planetree International outlines considerations and practical guidance for maximizing the therapeutic benefits of family participation while limiting the risk of spreading the virus. The document is especially timely as organizations revise visitation and family support policies for inpatient and long-term care stays as well as outpatient appointments now that Massachusetts is in Phase 3 of its re-opening effort.

The authors also contemplate what family presence and participation might look like in the post-COVID future and urge organizations to “build on what we learn and ensure that person-centered approaches to care continue to evolve and flourish in a safe, compassionate, and evidence-based manner.”

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Patient Safety Beat  is published by the  Betsy Lehman Center , a state agency that uses communications, research, and data to catalyze the efforts of providers, policymakers, and consumers working toward safer health care in Massachusetts.