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Comment and Response |

Perceptions of Safety Are Shaped by the Hospital Environment

G. Randy Smith, Jr, MD, FHM1; Vikram K. Devisetty, MD, MBA, MPH2,3; Debi L. Mitra, MD1
[+] Author Affiliations
1Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
3Operations, Northwestern Lake Forest Hospital, Lake Forest, Illinois
JAMA Intern Med. 2013;173(15):1471-1472. doi:10.1001/jamainternmed.2013.7741.
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To the Editor We commend Michtalik and colleagues1 for surveying hospitalists about how their workload affects patient care, but our own experiences in academic, community, veterans, and international hospitals lead us to question the reported “safe” census of 15 patients per shift, especially since the standard deviation for this number is not reported. We contend that the real threshold for safety diverges from this value based on the clinical setting and support structures in place.

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August 12, 2013
Henry J. Michtalik, MD, MPH, MHS; Peter J. Pronovost, MD, PhD; Daniel J. Brotman, MD
1Department of Medicine, Johns Hopkins University, Baltimore, Maryland3Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
2Department of Health Policy & Management, Johns Hopkins University, Baltimore, Maryland3Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
1Department of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2013;173(15):1472-1473. doi:.
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