A large number of patients use the Internet to find information that influences their attitudes to health care. The services of a medical informatics professional would likely benefit both patients and doctors.

There remain many ongoing barriers to physician engagement in quality and safety. Some high-performing hospitals in the USA have made significant improvements in engaging their physicians in quality and safety. The proposed framework can assist organisations in the development of strategies to engage physicians in quality-and-safety activities.

Background Preventable errors are common in healthcare. Over the last decade, Root Cause Analysis (RCA) has become a key tool for healthcare services to investigate adverse events and try to prevent them from happening again. The purpose of this paper is to highlight the work of the New South Wales (NSW) RCA Review Committee. The benefits of correctly classifying, aggregating and disseminating RCA data to clinicians will be discussed. In NSW, we perform an average of 500 RCAs per year. It is estimated that each RCA takes between 20 and 90 h to perform. In 2007, the NSW Clinical Excellence Commission (CEC) and the Quality and Safety Branch at the Department of Health constituted an RCA review committee. 445 RCAs were reviewed by the committee in 14 months. 41 RCAs were related to errors in managing acute coronary syndrome. Results and discussion The large number of RCAs has enabled the committee to identify emerging themes and to aggregate the information about underlying human (staff), patient and system factors. The committee has developed a taxonomy based on previous work done within health and aviation and assesses each RCA against this set of criteria. The effectiveness of recommendations made by RCA teams requires further review. There has been conjecture that staff do not feel empowered to articulate root causes which are beyond the capacity of the local service to address. Conclusion Given the number of hours per RCA, it seems a shame that the final output of the process may not in fact achieve the desired patient safety improvements.

Abuse cannot usually be determined by fracture type alone. Doctors in the ED miss indicators for abuse because they do not look for these indicators in the history and examination. Knowledge of indicators that raise suspicion of abuse is needed for a further forensic assessment to occur. The development of specific referral guidelines, ongoing education and a comprehensive injury form may improve referral of children from the ED to child protection.

Younger patients are at increased risk of osteochondroma following TBI. Review of the available literature suggests a low malignant potential of radiation-induced osteochondromas. Knowledge about the behaviour of post-irradiation osteochondromas will help clinicians manage patients appropriately.