COMMENTS AND RESPONSES Graduate Medical Education and Patient Safety TO THE EDITOR: I read with interest the excellent Quality Grand

semirural, nonteaching hospital, I was struck by the similarity of the case to a recent root-cause analysis performed at my hospital. These similarities include an unreported, unlooked-for imaging study; “an-choring bias ” (2); lack of a structured sign-out system; lack of com-munication between the admitting and covering physicians; and time and workload pressures. I was also struck that the authors ’ case analysis did not consider the nursing involvement in the care. The authors did not indicate whether the nurse was aware of why she was asked to insert a naso-gastric tube or whether this issue was recognized as a contributing cause. If the nurse or nurses involved had known the reason for the nasogastric tube, then the correct tube and, perhaps, the appropriate type of suction would have been used. At a time when medicine is increasingly systems- and protocol-driven and nursing care is increas-ingly task-oriented, having a team approach that includes the nursin