***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : There is widespread interest in improving medication safety , particularly in the hospital setting . Numerous suggestions have been made as to how this should be done , but there is a paucity of data demonstrating the effectiveness of any of the interventions that have been proposed . Objectives : To assess the impact of a wide ranging , community hospital based patient safety program on patient harm as measured by the rate of adverse drug events . Design : An audit of discharged hospital patients was conducted from January 2001 to December 2003 . Baseline data were collected for the first 6 months and multiple drug protocol s and other interventions were instituted on the nursing units and in the pharmacy department over the subsequent 9 months ( transition period ) . These interventions were largely based on information about medication risks acquired from internal medication event reporting . Each month of the study adverse drug events ( ADE ) were sought from a r and om sample of inpatient charts . A trigger tool was used to detect clues to ADEs , the presence of which was confirmed or excluded by detailed manual chart review . The severity of these events was categorized using the classification system of the National Coordinating Council for Medication Error and Reporting and Prevention . Main outcome measures and results : Median ADEs per 1000 doses of medication dispensed declined significantly from 2.04 to 0.65 ( p<0.001 ) . Median ADEs per 100 patient days declined significantly from 5.07 to 1.30 ( p<0.001 ) . The proportion of in patients with one or more ADE in the baseline period was 31 % and declined threefold ( p<0.001 ) . The severity of reported medication events also declined . The number of ADEs associated conclusively with patient harm was 1.67 per total doses delivered in the baseline period and declined eightfold ( p<0.001 ) . Conclusion : The implementation of a carefully planned series of low cost interventions focused on high risk medications , driven by information largely from internal event reporting , and design ed to improve a hospital ’s medication safety leads to a significant decrease in patient harm Objective . Medication errors are common among pediatric patients and in emergency departments ( EDs ) . Such errors may lead to prolonged hospitalization , unnecessary diagnostic tests and treatments , and death . The objective of this study was to determine whether the use of a structured order sheet reduces the incidence of medication errors in a pediatric ED . Methods . The study was a r and omized , controlled study that was conducted in a tertiary care pediatric hospital . Eighteen days were r and omized into 2 study groups : days during which the regular blank order sheets were used and days during which preprinted , formatted , order sheets were used .  All patients ’ charts from these days were review ed by 2 medical students , who extracted demographic , clinical , and therapeutic data into a data base . Two pediatric emergency physicians , blinded to the form used , review ed the data base and independently decided whether an error had occurred and the severity of the error . Results . Within the study period , there were 2157 visits to the ED . A total of 2058 ( 95.4 % ) charts were available for review . A total of 411 ( 52.2 % ) orders for drugs in the ED were ordered on the regular form , and 376 ( 47.8 % ) were given on the new form . Drug errors were identified in 68 ( 16.6 % ) orders when the regular form was used and in 37 ( 9.8 % ) of the orders on the new form . Using the new form was associated with a significant reduction in the risk for an error ( odds ratio : 0.55 ; 95 % confidence interval : 0.34–0.90 ) . Conclusions . The use of a preprinted structured order form significantly reduces medication errors among pediatric patients in the ED Objective : Comparison of two flooring types – carpet and vinyl – in the bed areas , and two modes of physiotherapy – conventional therapy and additional leg strengthening exercises – in avoiding falls . Design : R and omized 2 × 2 controlled trial . Setting : Elderly care rehabilitation ward in a community hospital . Subjects : Fifty-four consecutive patients referred for rehabilitation . Outcome measures : The incidence of falls , and the change in strength . Results : There were 10 falls on carpet , and only a single fall on vinyl floor covering ( relative risk 8.3 , 95 % confidence interval 0.95–73 , p = 0.05 ) . There were four falls in those receiving  additional exercise  , and seven falls in those receiving only conventional physiotherapy ( relative risk 0.21 , 95 % confidence interval 0.04–1.2 , p = 0.12 ) . Fifty-nine per cent of patients were able to complete strength measurements on admission and discharge . In these , h and grip strength improved more in those given additional exercise than conventional physiotherapy ( 2.1 kg versus – 0.3 kg , p < 0.05 ) . Conclusion : There is no evidence to support either intervention in preventing falls on a rehabilitation ward , but within this low-powered study , there was a strong trend towards vinyl being superior Problem : Advance cardiac life support ( ACLS ) training does not address coordination of team re sources to improve the ability of teams to deliver needed treatments reliably and rapidly . Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team ( MET ) performance . We report findings of a crisis team training course that is focused on organization . Setting : Large center for human simulation training at a university affiliated tertiary care hospital . Participants : Ten courses were delivered and 138 clinical ly experienced individuals were trained ( 69 critical care nurses , 48 physicians , and 21 respiratory therapists ) . All participants were ACLS trained and experienced in responding to cardiac arrest situations . Course design : Each course had four components : ( 1 ) a web based presentation and pretest before the course ; ( 2 ) a brief reinforcing didactic session on the day of the course ; ( 3 ) three of five different simulated scenarios ; each followed by ( 4 ) debriefing and analysis with the team . Three of five simulator scenarios were used ; scenario selection and order was r and om . Trainees did not repeat any scenario or role during the training . Participants were video recorded to assist debriefing . Debriefing focused on reinforcing organizational aspects of team performance : assuming design ated roles independently , completing goals ( tasks ) assigned to each role , and directed communication . Measures for improvement : Participants grade d their performance of specific organizational and treatment tasks within specified time intervals by consensus . Simulator “ survival ” depended on supporting oxygenation , ventilation , circulation within 60 seconds , and delivering the definitive treatment within 3 minutes . Effects of change : Simulated survival ( following predetermined criteria for death ) increased from 0 % to 89 % . The initial team task completion rate was 10–45 % and rose to 80–95 % during the third session . Lessons learnt : Training multidisciplinary teams to organize using simulation technology is feasible . This preliminary report warrants more detailed inquiry Background : Until recently , the preparation of paediatric parenteral nutrition formulations in our institution included re-transcription and manual compounding of the mixture . Although no significant clinical problems have occurred , re-engineering of this high risk activity was undertaken to improve its safety . Several changes have been implemented including new prescription software , direct recording on a server , automatic printing of the labels , and creation of a file used to pilot a BAXA MM 12 automatic compounder . The objectives of this study were to compare the risks associated with the old and new processes , to quantify the improved safety with the new process , and to identify the major residual risks . Methods : A failure modes , effects , and criticality analysis ( FMECA ) was performed by a multidisciplinary team . A cause-effect diagram was built , the failure modes were defined , and the criticality index ( CI ) was determined for each of them on the basis of the likelihood of occurrence , the severity of the potential effect , and the detection probability . The CIs for each failure mode were compared for the old and new processes and the risk reduction was quantified . Results : The sum of the CIs of all 18 identified failure modes was 3415 for the old process and 1397 for the new ( reduction of 59 % ) . The new process reduced the CIs of the different failure modes by a mean factor of 7 . The CI was smaller with the new process for 15 failure modes , unchanged for two , and slightly increased for one . The greatest reduction ( by a factor of 36 ) concerned re-transcription errors , followed by readability problems ( by a factor of 30 ) and chemical cross contamination ( by a factor of 10 ) . The most critical steps in the new process were labelling mistakes ( CI 315 , maximum 810 ) , failure to detect a dosage or product mistake ( CI 288 ) , failure to detect a typing error during the prescription ( CI 175 ) , and microbial contamination ( CI 126 ) . Conclusions : Modification of the process result ed in a significant risk reduction as shown by risk analysis . Residual failure opportunities were also quantified , allowing additional actions to be taken to reduce the risk of labelling mistakes . This study illustrates the usefulness of prospect i ve risk analysis methods in healthcare processes . More systematic use of risk analysis is needed to guide continuous safety improvement of high risk activities BACKGROUND We have little systematic information about the extent to which st and ard processes involved in health care -- a key element of quality --are delivered in the United States . METHODS We telephoned a r and om sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences . We also received written consent to copy their  medical records  for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care . We then constructed aggregate scores . RESULTS Participants received 54.9 percent ( 95 percent confidence interval , 54.3 to 55.5 ) of recommended care . We found little difference among the proportion of recommended preventive care provided ( 54.9 percent ) , the proportion of recommended acute care provided ( 53.5 percent ) , and the proportion of recommended care provided for chronic conditions ( 56.1 percent ) . Among different medical functions , adherence to the processes involved in care ranged from 52.2 percent for screening to 58.5 percent for follow-up care . Quality varied substantially according to the particular medical condition , ranging from 78.7 percent of recommended care ( 95 percent confidence interval , 73.3 to 84.2 ) for senile cataract to 10.5 percent of recommended care ( 95 percent confidence interval , 6.8 to 14.6 ) for alcohol dependence . CONCLUSIONS The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public . Strategies to reduce these deficits in care are warranted Background : Research into adverse events ( AEs ) has highlighted the need to improve patient safety . AEs are unintended injuries or complications result ing in death , disability or prolonged hospital stay that arise from health care management . We estimated the incidence of AEs among patients in Canadian acute care hospitals . Methods : We r and omly selected 1 teaching , 1 large community and 2 small community hospitals in each of 5 provinces ( British Columbia , Alberta , Ontario , Quebec and Nova Scotia ) and review ed a r and om sample of charts for nonpsychiatric , nonobstetric adult patients in each hospital for the fiscal year 2000 .  Trained review ers screened all eligible charts , and physicians review ed the positively screened charts to identify AEs and determine their preventability . Results : At least 1 screening criterion was identified in 1527 ( 40.8 % ) of 3745 charts . The physician review ers identified AEs in 255 of the charts . After adjustment for the sampling strategy , the AE rate was 7.5 per 100 hospital admissions ( 95 % confidence interval [ CI ] 5.7– 9.3 ) . Among the patients with AEs , events judged to be preventable occurred in 36.9 % ( 95 % CI 32.0%–41.8 % ) and death in 20.8 % ( 95 % CI 7.8%–33.8 % ) . Physician review ers estimated that 1521 additional hospital days were associated with AEs . Although men and women experienced equal rates of AEs , patients who had AEs were significantly older than those who did not ( mean age [ and st and ard deviation ] 64.9 [ 16.7 ] v. 62.0 [ 18.4 ] years ; p = 0.016 ) . Interpretation : The overall incidence rate of AEs of 7.5 % in our study suggests that , of the almost 2.5 million annual hospital admissions in Canada similar to the type studied , about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable The patient 's problem is recurrent cough . Pulmonary function is normal at the moment , but the patient 's symptoms and family history suggest asthma . Three physicians confer . Physician A suggests inhalant therapy . It 's almost surely asthma , he says . We should begin treatment and move on to the next patient . The best therapy for asthma is an inhaled steroid . Case closed . Wait a moment , says Physician B. You ca n't be so sure that the best therapy is a steroid . -adrenergics may be better . We need to enroll this patient in a r and omized , double-blind trial to increase our certainty about the best medication . Let 's get informed consent and draw lots to assign the patient r and omly to a treatment group . I 've got a better plan than either of you , says Physician C. Our task is to find out what will help this patient , recognizing our uncertainty about both the diagnosis and the best treatment . Let 's run a small-scale test . We 'll begin with the assumption that the patient has asthma and , on the basis of the scientific literature , we 'll 
    Output:
    
The collected evidence on risk reduction concerns a variety of interventions to reduce medication errors , fall incidents , diagnostic errors , and adverse events in general .
Most studies reported positive effects ; however , interventions were often multifaceted , and it was difficult to disentangle their impact .