Articles of Interest
Uncovering Latent Failures Using Human Factors Approach as a Diagnostic Tool for Quality Improvement in Orthopedic Surgery
Khan, A, Cohen, T, Shappell, S & Boquet, A. (2025). Uncovering Latent Failures Using Human Factors Approach as a Diagnostic Tool for Quality Improvement in Orthopedic Surgery. American Journal of Medical Quality, 40, 255-260. https://doi.org/10.1097/JMQ.0000000000000265
Abstract
Human factors significantly influence medical quality, especially in complex environments like orthopedic surgery, where latent failures can compromise patient safety. A total of 3168 intraoperative events were observed across 40 orthopedic procedures and classified using the Human Factors Analysis and Classification System (HFACS). Three trained coders independently applied HFACS across 4 tiers and 19 causal categories. Interrater reliability was measured through percent agreement and Fleiss' Kappa using unanimous, majority, and reconciled coding conditions. Nearly all observed disruptions (98.97%) were classified as preconditions to unsafe acts, most (68.75%) stemmed from crew resource management failures, distractions from personal electronic devices, poor communication, and sales representative presence. A total of 19.47% of disruptions were due to personal readiness, due to the sales representation supporting role in ensuring technologies. An additional 5.87% were due to physical environment issues like equipment noise.
Conclusions: The HFACS framework demonstrated strong reliability in identifying systemic weaknesses within orthopedic surgical workflows. These findings emphasize the urgent need for structured interventions that reduce distractions, improve team communication, and regulate vendor interactions in the operating room, all essential steps toward advancing safety and enhancing overall patient care quality.
AI-Enabled Medical Devices Drive Nearly Half of All Recalls in First Year After 510(k) Approval
(2026). AI-Enabled Medical Devices Drive Nearly Half of All Recalls in First Year After 510(k) Approval. Biomedical Safety & Standards, 56 (3), 143-144. doi: 10.1097/01.BMSAS.0001179456.60494.10.
Excerpt:
A recent study in JAMA Health Forum found that artificial intelligence-enabled medical devices (AIMDs), nearly all of which are cleared via the 510(k) approval pathway, account for a much higher rate of early recalls compared with other types of devices.
Integration of intelligent sensory techniques and flavoromics to elucidate the emotion-regulating mechanisms of citrus essential oils aroma
Ye, Zhiyue , Liu, Feifei , Chen, Jin , et al,
Integration of intelligent sensory techniques and flavoromics to elucidate the emotion-regulating mechanisms of citrus essential oils aroma, Food Quality and Safety, This article is not yet published in a specific volume/issue.
Abstract
Mood foods affect emotion and cognition largely through flavor and other sensory properties, with citrus essential oils (EOs) representing key functional ingredients. Nevertheless, the mechanisms underlying their emotional effects have not been fully elucidated. This study introduces an integrative approach combining subjective evaluation using the emotion and odor scale and intelligent sensory detection technologies, including electrocardiogram (ECG), electrodermal activity (EDA), and electroencephalography (EEG), to systematically evaluate the emotional effects of citrus aromas. Multimodal analysis demonstrated that citrus EOs significantly decreased the low frequency to high frequency power (LF/HF) ratio, indicating enhanced parasympathetic activity linked to relaxation and mood improvement. EEG findings revealed increased power in the α (8-13 Hz) and δ (0.5-4 Hz) bands. Notably, navel orange, blood orange, and grapefruit EOs elicited pronounced α-band activation in the frontal, right parietal, and occipital regions. These EOs also enhanced hemispheric asymmetry in the parietal and occipital lobes, which are correlated with positive emotional regulation. Through integrated analysis of multimodal data and flavoromics (chromatography-olfactometry-mass spectrometry, odor activity value) data, ᴅ-limonene, linalool, α-terpineol, and geranial were identified as key bioactive volatiles associated with improved emotional outcomes. By liking aroma profiling with physiological and neural markers, this study shows how citrus volatiles influence mood, highlighting their potential application in functional foods and nutraceutical applications.
Long-Term Sustainability of QI Interventions: Outcomes in Opioid Prescribing for Postoperative Care
Andrii Khomiak, MD, PhD; Joshua D. Billings, MD; Victoria Huynh, MD; Laura D. Leonard, MD; Viviane L. Abud, MD; Teresa L. Jones, MD; Salvador Rodriguez Franco, MD; Ioannis A. Ziogas, MD; Kyle Bata, MS; Nicole Christian, MD; Marco Del Chiaro, MD, PhD; Ethan Cumbler, MD; Sarah E.A. Tevis, MD
Joint Commission Journal on Quality and Patient Safety, The, January 01, 2026, Volume 52, Issue 1, Pages 26-32
Abstract
Introduction
The ideal approach to safely reduce the rising rates of cesarean deliveries (CD) is unknown. We evaluated the impact of a multi-faceted quality improvement initiative aimed at curbing the rising trend in the institutional nulliparous term singleton vertex (NTSV) CD rate at an urban, academic, safety-net hospital.
Methods
The primary intervention was a bi-weekly interdisciplinary educational meeting, wherein NTSV CD cases were reviewed and audited. In addition, an educational bulletin, NTSV score cards, labor position training, and efforts to promote guideline adherence were introduced. We examined the institutional NTSV CD rates by quarters and evaluated the trend, modeling the probability of a CD for the pre and post intervention periods using logistic regression with time as an ordinal variable. We also examined cesarean indications as well as maternal and neonatal complications before and after the QI implementation.
Results
There was a trend towards a decrease in CDs during the post-intervention period, falling from 32.9% to 25% in the twelve months following implementation. Using an interrupted time series analysis to assess differences in trends, the trend before intervention was +2.63% per quarter (p < 0.001, 95% CI 2.30-3.03), while the change in trend post-intervention was -3.78% per quarter (p < 0.001, 95% CI -4.74, -2.81, R 2 =0.973). This suggests an increasing trend prior to intervention that was effectively reversed. Both maternal and neonatal complications rate remained comparable between pre- and post-intervention periods for those who had NTSV CDs.
Conclusion
Multifaceted strategies incorporating interactive case review meetings can lead to practice change and may be a feasible strategy to reduce an institutional NTSV CD rate.
Reducing Medication-related Inappropriateness in Older Adults: A Systematic Review and Meta-analysis
Kim, J. , Terry, D. & Nguyen, H. (2026). Reducing Medication-related Inappropriateness in Older Adults: A Systematic Review and Meta-analysis. Journal of Patient Safety, 22 (1), 1-8. doi: 10.1097/PTS.0000000000001406.
Abstract
Background:
The opioid epidemic remains a critical public health challenge. This study aimed to assess the sustainability of improved opioid prescribing practices following the implementation of an intervention in the postoperative clinical setting.
Methods:
Conducted as a quality improvement (QI) initiative at an academic medical center, this pre-post interventional study spanned four phases: preimplementation (October 2019–June 2020), implementation (July–December 2020), and postimplementation (January–December 2021), followed by the sustainability phase (January 2022–November 2023). The authors examined opioid-naïve patients ≥ 18 years undergoing procedures under specified Current Procedural Terminology (CPT) codes. Interventions included education and monthly feedback reports based on Opioid Prescribing Engagement Network (OPEN) guidelines. Descriptive statistics were used to summarize data; chi-square test was used to compare categorical variables.
Results:
The postimplementation cohort consisted of 2,513 patients vs. 2,290 in the preimplementation group, with statistically similar baseline characteristics. We observed a compliance increase to 68.9% vs. 45.1% ( p < 0.001). The sustainability cohort included 4,976 patients and had a further increase to 80.1% compliance compared to the postimplementation cohort ( p < 0.001). Residents (nonresident prescribers include advanced practice providers and attending surgeons) were more likely to be prescribing providers in postimplementation vs. sustainability cohort, 39.6% vs. 22.2% ( p < 0.001). Subanalysis was conducted across 12 consecutive months comparing the period with a consistent distribution of performance reports with the period when no performance reminders were sent for the previous month (November 2022–May 2023 vs. June–November 2023). The compliance rates for these two subperiods did not differ (82.04% vs. 81.98%, respectively, p = 0.97).
Conclusions:
This study’s data demonstrate that a well-structured QI initiative can lead to sustained improvements in opioid prescribing practices and “enculturation” to maintain long-term change within an institution.
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