Jeffrey L Schnipper

• Brigham and Women's Hospital

Background: Hospital medicine programs use backup ("jeopardy") systems to cover unexpected staffing gaps, but little is known about their structures or optimal practices. Objectives: To describe jeopardy structures, assess clinician perceptions, and identify potential approaches across a broad sample of hospital medicine groups. Methods: This...

Although inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) aims at matching patients’ care needs to appropriate sites of care, IHT practices are variable leaving some patients vulnerable to risks of discontinuity of care without clear benefit. Identifying which patients may not need IHT can help to prevent inappro...

Racial and ethnic minorities experience a disproportionate burden of the type 2 diabetes (T2D) and are at a 2 to 5 times higher risk of developing macrovascular disease. The purpose of the study was to describe the perspectives of Haitian American immigrants’ challenges to effective T2D self-management. Utilizing a descriptive qualitative approach,...

Background Workplace violence prevention programs are important for safety, but little is known about how they are perceived by clinicians or whether electronic health record (EHR) behavioral alerts are perceived as effective. Objective To understand perspectives on the use of EHR behavioral alerts as part of workplace violence prevention programs...

Patients who reside in areas of high neighborhood disadvantage have poorer health outcomes; the mechanisms for this disparity are complex. We sought to determine if there was an association between neighborhood disadvantage and diagnostic error among a cohort of adult inpatients who experienced either an ICU transfer or in‐hospital death. Using a s...

Background Serious Illness Conversations (SICs) are not consistently integrated into existing inpatient workflows. Objective We assessed the implementation of multiple interventions aimed at encouraging SICs with hospitalized patients. Methods We used the Consolidated Framework for Implementation Research to identify determinants for conducting S...

Background Adverse event surveillance approaches underestimate the prevalence of harmful diagnostic errors (DEs) related to hospital care. Methods We conducted a single-centre, retrospective cohort study of a stratified sample of patients hospitalised on general medicine using four criteria: transfer to intensive care unit (ICU), death within 90 d...

Objectives This study aimed to pilot an application-based patient diagnostic questionnaire (PDQ) and assess the concordance of the admission diagnosis reported by the patient and entered by the clinician. Methods Eligible patients completed the PDQ assessing patients' understanding of and confidence in the diagnosis 24 hours into hospitalization ei...

Many patients are unable to identify members of their hospital care team and experience confusion regarding some medical terminology used during hospitalization, including descriptions of the structure of their inpatient care team. This cross‐sectional study sought to (1) examine inpatients' understanding of the role of a hospitalist and (2) assess...

Objectives Post-discharge adverse events (AEs) are common and heralded by new and worsening symptoms (NWS). We evaluated the effect of electronic health record (EHR)-integrated digital tools designed to promote quality and safety in hospitalized patients on NWS and AEs after discharge. Materials and Methods Adult general medicine patients at a com...

Patients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing of discharge a clinical and operational challenge. To determine risks for post-discharge readmission and death among patients hospitalized with COVID-19. Multicenter retrospective observational cohort study, 2020–2021, with 30-d...

Importance Timely diagnosis and treatment are of paramount importance for patients with head and neck cancer (HNC) because delays are associated with reduced survival rates and increased recurrence risk. Prompt referral to HNC specialists is crucial for the timeliness of care, yet the factors that affect the referral and triage pathway remain relat...

Knees M, Raffel KE, Kissler M, Burden M, Porter S, Schnipper J, Auerbach A. Cognitive Load Theory and its Impact on Diagnostic Accuracy. Rockville, MD: Agency for Healthcare Research and Quality; 2024. Publication No. 24-0010-2-EF. https://www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-cognitive-load.html

Disparities in opioid prescribing among racial and ethnic groups have been observed in outpatient and emergency department settings, but it is unknown whether similar disparities exist at discharge among hospitalized older adults. To determine filled opioid prescription rates on hospital discharge by race/ethnicity among Medicare beneficiaries. Ret...

The presence of racial and ethnic disparities in interhospital transfer (IHT) within integrated healthcare systems has not been fully explored. We matched Black and Latinx patients admitted to community hospitals in our integrated healthcare system between June 2015 and December 2019 to White patients by origin hospital, age, time of year, and dise...

Background Analysis of documented Serious Illness Conversations (SICs) in the inpatient setting can help clinicians align management to address patient and caregiver needs. Methods We conducted a mixed methods analysis of the first instance of standardized documentation of a SIC within a structured module among hospitalized general medicine patien...

Importance Diagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients. Objective To determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalized adults transferred to an intensive care unit (ICU) or who died. Design, Setting, and P...

During the coronavirus disease 2019 (COVID-19) pandemic, hospitals and healthcare systems launched innovative responses to emerging needs. The creation and use of programs to remotely follow patient clinical status and recovery after COVID-19 hospitalization has not been thoroughly described. To characterize deployment of remote post-hospital disch...

Optimal medication management is important during hospitalization and at discharge because post-discharge adverse drug events (ADEs) are common, often preventable, and contribute to patient harms, healthcare utilization, and costs. Conduct a cost analysis of a comprehensive pharmacist-led transitions-of-care medication management intervention for o...

Importance The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to communication errors and gaps in information exchange. Objective To design and implement a standardised accept note to improve communication during medical service transfers, and evaluate its impact on patient outcomes. Design Prospective inte...

Background Few hospitals have built surveillance for diagnostic errors into usual care or used comparative quantitative and qualitative data to understand their diagnostic processes and implement interventions designed to reduce these errors. Objectives To build surveillance for diagnostic errors into usual care, benchmark diagnostic performance a...

Objectives As part of a study to assess whether a technologically enabled pillbox prescribed to patients at hospital discharge can improve medication safety, we sought to assess participant experiences with the intervention. Methods We conducted a series of semi-structured phone interviews with patients, patient caregivers, and inpatient and outpat...

Background: Serious Illness Conversations (SICs) conducted during hospitalization can lead to meaningful patient participation in the decision-making process affecting medical management. The aim of this study is to determine if standardized documentation of a SIC within an institutionally approved EHR module during hospitalization is associated wi...

Introduction Accurate estimation of an expected discharge date (EDD) early during hospitalization impacts clinical operations and discharge planning. Methods We conducted a retrospective study of patients discharged from six general medicine units at an academic medical center in Boston, MA from January 2017 to June 2018. We retrieved all EDD entr...

Importance: Hospital readmissions are frequent, costly, and sometimes preventable. Although these issues have been well publicized and incentives to reduce them introduced, the best interventions for reducing readmissions remain unclear. Objectives: To evaluate the effects of a multimodal transitional care intervention targeting patients at high...

Background: Despite the high prevalence and significant health effects of intimate partner violence (IPV), little is known about its associations with hospitalization. Objective: To perform a scoping review of how IPV impacts hospitalization rates, characteristics, and outcomes in adult patients. Data sources: A search of four databases (MEDLI...

Background Patient understanding of their care, supported by physician involvement and consistent communication, is key to positive health outcomes. However, patient and care team characteristics can hinder this understanding.Objective We aimed to assess inpatients’ understanding of their care and their perceived receipt of mixed messages, as well...

Background: The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs). Objective: To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COV...

Hospital readmissions within 30 days represent a burden for the patients and the entire health care system. Improving the care around hospital discharge period could decrease the risk of avoidable readmissions. We describe the methods of a trial that aims to evaluate the effect of a structured multimodal transitional care intervention targeted to h...

Background: Type 2 diabetes (T2D) is a chronic condition affecting more than 34.2 million United States adults, and people of African descent have a disproportionate burden. Haitian immigrants' unique cultural and biologic factors put them at elevated risk for T2D-related complications. Despite prior research highlighting the success of multimetho...

Background: Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow...

Objectives Geriatric guidelines strongly recommend avoiding benzodiazepines and non-benzodiazepine sedative hypnotics in older adults. Hospitalisation may provide an important opportunity to begin the process of deprescribing these medications, particularly as new contraindications arise. We used implementation science models and qualitative interv...

Introduction Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Con...

Medication errors during transitions of care are common, dangerous and costly. Medication reconciliation can help mitigate this risk, but it is a complex and time-consuming process when performed properly. Increasingly, pharmacy staff have been engaged to help improve medication reconciliation. However, many organizations lack the resources and sta...

Background: Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. Objective: To determine if I-PASS implementation across diverse settin...

Background Home hospital (HH) is hospital-level substitutive care delivered at home for acutely ill patients who would traditionally be cared for in the hospital. Despite HH programs operating successfully for years, and scientific evidence of similar or better outcomes compared to bricks and mortar care, HH outcomes in the US for respiratory disea...

Background Diagnostic errors (DE) have been studied extensively in ambulatory care, but less work has been done in the acute care setting. In this study, we examined healthcare providers’ and patients’ perspectives about the classification of DEs, the main causes and scope of DEs in acute care, the main gaps in current systems, and the need for inn...

Background Adverse drug events are common during transitions of care. As part of the Smart Pillbox study, a cluster-randomized controlled trial of an electronic pillbox designed to reduce medication discrepancies and improve medication adherence after hospital discharge, we explored barriers to successful implementation and evaluation of this inter...

Serious Illness Conversations (SICs) explore patients’ prognostic awareness, hopes, and worries, and can help establish priorities for their care during and after hospitalization. While identifying patients who benefit from an SIC remains a challenge, this task may be facilitated by use of validated prediction scores available in most commercial el...

Importance: Home hospital care is the substitutive provision of home-based acute care services usually associated with a traditional inpatient hospital. Many home hospital models require a physician to see patients at home daily, which may hinder scalability. Whether remote physician visits can safely substitute for most in-home visits is unknown....

Objectives To test a structured electronic health record (EHR) case review process to identify diagnostic errors (DE) and diagnostic process failures (DPFs) in acute care. Methods We adapted validated tools (Safer Dx, Diagnostic Error Evaluation Research [DEER] Taxonomy) to assess the diagnostic process during the hospital encounter and categorize...

Background and objectives: Hypertension management has several challenges, including poor compliance with medications and patients being lost to follow-up. Recently, remote patient monitoring and telehealth technologies have emerged as promising methods of blood pressure management. We aimed to investigate the role of application-based telehealth...

Background Early reports of increased thrombosis risk with SARS-CoV-2 infection led to changes in venous thromboembolism (VTE) management. Real-world data on the prevalence, efficacy and harms of these changes informs best practices. Objective Define practice patterns and clinical outcomes related to VTE diagnosis, prevention, and management in ho...

Objectives The ability to deliver SNF-level care at home is unclear. We sought to demonstrate the feasibility of rehabilitation at home (RAH) via a pilot randomized controlled trial. Methods Daily care from a home health aide, certified nursing assistant, nurse, and physician. Core technologies included remote PT, automated medication dispensing,...

This survey study aimed to provide a contemporary appraisal of advanced practice provider (APP) practice and to summarize perceptions of the benefits and challenges of integrating APPs into adult academic hospital medicine (HM) groups. We surveyed leaders of academic HM groups. We received responses from 43 of 86 groups (50%) surveyed. Thirty‐four...

Recent hospitalization puts older adults at higher risk of experiencing adverse drug events (ADEs) that are a common cause of hospital readmission. Yet, most ADEs are preventable. The PHARMacist Discharge Care (PHARM-DC) study is a multi-site randomized controlled trial that seeks to evaluate the effect of pharmacist-led peri- and post-discharge in...

Introduction: Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Co...

Researchers and patients conducted an environmental scan of policy documents and public-facing websites and abstracted data to describe COVID-19 adult inpatient visitor restrictions at 70 academic medical centers. We identified variations in how centers described and operationalized visitor policies. Then, we used the nominal group technique proces...

Objectives We describe an approach for analyzing failures in diagnostic processes in a small, enriched cohort of general medicine patients who expired during hospitalization and experienced medical error. Our objective was to delineate a systematic strategy for identifying frequent and significant failures in the diagnostic process to inform strate...

Background: Failure of safe care transitions after hospital discharge results in unnecessary worsening of symptoms, extended period of illness or readmission to the hospital. Objective: The objective of this study was to add to the understanding of the working of care transition interventions between hospital and home through unraveling the cont...

Background: Despite the well-documented risks to patient safety associated with transitions from one care setting to another, health care organizations struggle to identify which interventions to implement. Multiple strategies are often needed, and studying the effectiveness of these complex interventions is challenging. Objective: The objective...

Background Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and provide...

Background : Unintentional medication discrepancies due to inadequate medication reconciliation pose a threat to patient safety. Skilled nursing facilities (SNFs) are an important care setting where patients are vulnerable to unintentional medication discrepancies due to increased medical complexity and care transitions. This study describes a qual...

Background The first Multicenter Medication Reconciliation Quality Improvement (QI) Study (MARQUIS1) demonstrated that mentored implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The objective of this study was to determine the ef...

Background: There are currently no evidence-based guidelines that provide standardized criteria for the discharge of COVID-19 patients from the hospital. Objective: To address this gap in practice guidance, we reviewed published guidance and collected discharge protocols and procedures to identify and synthesize common practices. Design: Rapid...

Background Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials h...

Importance Interhospital transfer (IHT) of patients is a common occurrence in modern health care. Racial/ethnic disparities are prevalent throughout US health care, but their presence in IHT is not well characterized. Objective To determine if there are racial/ethnic disparities in IHT for medical diagnoses for which IHT is associated with a morta...

Purpose To identify interventions for organizational pharmacist-leaders and frontline pharmacy staff to optimize peri- and postdischarge medication management. Summary An evidence-based toolkit was systematically constructed on the basis of findings of 3 systematic overviews of systematic reviews. The interventions were reviewed by a technical exp...

Objective To evaluate the effect of electronic health record (EHR)-integrated digital health tools comprised of a checklist and video on transitions-of-care outcomes for patients preparing for discharge. Materials and Methods English-speaking, general medicine patients (>18 years) hospitalized at least 24 hours at an academic medical center in Bos...

Background: Transitions from hospital to the ambulatory setting are high risk for patients in terms of adverse events, poor clinical outcomes, and readmission. Objectives: To develop, implement, and refine a multifaceted care transitions intervention and evaluate its effects on postdischarge adverse events. Design, setting, and participants: T...

As the Coronavirus disease 2019 (COVID-19) pandemic spread to the US, so too did descriptions of an associated coagulopathy and thrombotic complications. Hospitals created institutional protocols for inpatient management of COVID-19 coagulopathy and thrombosis in response to this developing data. We collected and analyzed protocols from 21 US acade...

The aim of this study was to identify the combinations of chronic comorbidities associated with length of stay (LOS) among multimorbid medical inpatients. Multinational retrospective cohort of 126,828 medical inpatients with multimorbidity, defined as ≥2 chronic diseases (data collection: 2010–2011). We categorized the chronic diseases into comorbi...

Importance: Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. Objective: To characterize inpatient adaptations to care for non-ICU COVID-19 patients. Design: Cross-sectional surv...

Background Interhospital transfer (IHT) is often performed to provide patients with specialized care. Racial/ethnic disparities in IHT have been suggested but are not well-characterized.Objective To evaluate the association between race/ethnicity and IHT.DesignCross-sectional analysis of 2016 National Inpatient Sample data.PatientsPatients aged ≥ 1...

Introduction: The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. Frontline providers are the key individuals participating in handoffs of patient care. It is important they receive robust handoff training. Methods: The I-PASS Mentore...

For health information technology to realize its potential to improve flow, care, and patient safety, applications should be intuitive to use and burden neutral for frontline clinicians. We assessed the impact of a patient safety dashboard on clinician cognitive and work load within a simulated information-seeking task for safe inpatient opioid med...

Objectives: Successful efforts to improve transitional care depend in part on local attitudes, workload, and training. Before implementing a multifaceted transitions intervention within an Accountable Care Organization, an understanding of contextual factors among providers involved in care transitions in inpatient and outpatient settings was need...

Objective: To compare different definitions of multimorbidity to identify patients with higher health care resource utilization. Patients and methods: We used a multinational retrospective cohort including 147,806 medical inpatients discharged from 11 hospitals in 3 countries (United States, Switzerland, and Israel) between January 1, 2010, and...

Background Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems. Objective T...

Purpose High-quality medication reconciliation reduces medication discrepancies, but smaller hospitals serving rural patients may have difficulty implementing this because of limited resources. We sought to adapt and implement an evidence-based toolkit of best practices for medication reconciliation in smaller hospitals, evaluate the effect on unin...

Objective: The objective of this paper is to share challenges, recommendations, and lessons learned regarding the development and implementation of a Patient Safety Learning Laboratory (PSLL) project, an innovative and complex intervention comprised of a suite of Health Information Technology (HIT) tools integrated with a newly implemented Electro...

Objectives Medication reconciliation (MedRec) is an important patient safety strategy and is widespread in US hospitals and globally. Nevertheless, high quality MedRec has been difficult to implement. As part of a larger study investigating MedRec interventions, we evaluated and compared organisational contextual factors and team cohesion by hospit...

Purpose To systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy. Summary MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched for SRs evaluating interventions addressing polypharmacy in adults...

Background: The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lesson...

It is unclear which medication reconciliation interventions are most effective at reducing inpatient medication discrepancies. Five United States hospitals' interdisciplinary quality improvement (QI) teams were virtually mentored by QI-trained physicians. Sites implemented one to seven evidence-based interventions in 791 patients during the 25-mont...

BACKGROUND Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for a discharge have potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR). OBJECTIVE To evaluate the implem...

Background: Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for discharge have the potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR). Objective: This study aims...

Background: Multimorbidity is associated with higher healthcare utilization; however, data exploring its association with readmission are scarce. We aimed to investigate which most important patterns of multimorbidity are associated with 30-day readmission. Methods: We used a multinational retrospective cohort of 126,828 medical inpatients with...

Objectives: Patients with diabetes are at particularly high risk for adverse outcomes after hospitalization. The goals of this study were to design, implement, and evaluate a multipronged transitional care intervention among hospitalized patients with diabetes. Methods: We randomly assigned inpatients likely to be discharged home on insulin to a...

Background Health research is evolving to include patient stakeholders (patients, families and caregivers) as active members of research teams. Frameworks describing the conceptual foundations underlying this engagement and strategies detailing best practice activities to facilitate engagement have been published to guide these efforts. Objective...

Background Inter-hospital transfer (IHT, the transfer of patients between hospitals) occurs regularly and exposes patients to risks of discontinuity of care, though outcomes of transferred patients remains largely understudied. Objective To evaluate the association between IHT and healthcare utilisation and clinical outcomes. Design Retrospective...

Background Unintentional discrepancies across care settings are a common form of medication error and can contribute to patient harm. Medication reconciliation can reduce discrepancies; however, effective implementation in real-world settings is challenging. Methods We conducted a pragmatic quality improvement (QI) study at five US hospitals, two...

A. SHM I-PASS Mentored Implementation Guide.pdf B. SHM I-PASS Mentored Implementation Guide.docx C. I-PASS Training Materials Tips and Tricks.docx D. I-PASS Handoff Program Implementation Steps.docx

Objectives: Although existing data suggest marked variability in interhospital transfer (IHT), little is known about specific factors that may impact the quality and safety of this care transition. We aimed to explore transferred patients' and involved physicians' experience with IHT to better understand the components of the transfer continuum an...

Background: Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame. Objective: To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharg...

Objectives The Common Formats, published by the Agency for Healthcare Research and Quality, represent a standard for safety event reporting used by Patient Safety Organizations (PSOs). We evaluated its ability to capture patient-reported safety events. Materials and methods We formally evaluated gaps between the Common Formats and a safety concern...

Background: Follow-up of tests pending at discharge (TPADs) is poor. We previously demonstrated a twofold increase in awareness of any TPAD by attendings and primary care physicians (PCPs) using an automated email intervention OBJECTIVE: To determine whether automated notification improves documented follow-up for actionable TPADs DESIGN: Cluster-...