Rates of prescription opioid misuse and abuse led to recommendations for dose tapering for patients with chronic pain. However, concerns have been raised about the potential harms associated with rapidly decreasing doses or discontinuing opioids. Building on previous research, these researchers used a large claims database to explore the unintended negative consequences of tapering patients on stable, long-term opioid therapy. Findings indicate that opioid tapering was associated with fewer primary care visits, greater numbers of emergency department visits, and reduced adherence to antihypertensive and antidiabetic medications.

Metacognition (e.g., when one reflects on one’s own decision and decision making) is an approach to reducing diagnostic errors. Using data from the Melanoma Pathology Study (M-PATH) and Breast Pathology Study (B-PATH), researchers assed pathologists’ metacognition by examining their diagnostic accuracy and self-confidence. Results showed pathologists with increased metacognition sensitivity were more likely to request a second opinion for incorrect diagnosis than they were for a correct diagnosis.

Sudden discontinuation of opioids has been linked to increased patient harm. This observational study evaluated the link between tapering and overdose, and mental health crisis among patients who were receiving long-term opioid therapy. Patients who underwent dose tapering had an increased risk of overdose and mental health crisis compared to those who did not undergo dose tapering. 

This study surveyed over 22,800 patients across three health care organizations to assess how often patients who read open ambulatory visit notes perceive mistakes in the notes. The analysis found that 4,830 patients (21%) perceived a mistake in one or more notes in the past 12 months and that 42% of those patients considered the mistake to be somewhat or very serious. The most common very serious mistakes involved incorrect diagnoses; medical history; allergy or medication; or tests, procedures, or results. Older and sicker patients were more likely to report a serious error compared to younger and healthier patients. Using open notes and encouraging patient engagement can improve record accuracy and prevent medical errors

This study held focus groups with breast cancer providers to better understand attitudes and experiences regarding communicating with patients about diagnostic errors. Researchers presented three hypothetical vignettes for discussion. Participants identified challenges related specifically to breast cancer as well as challenges stemming from team-based care. To improve communication about these errors, participants recommended educating patients, being honest and empathetic, and focus on the positive and the patient’s future.

OpenNotes provides patients with access to their health care provider’s documentation. This study found that patient access to such documentation may have the potential to improve medication adherence. A past PSNet interview discussed the OpenNotes project.

Obstetrics is a high-risk practice that concurrently manages the safety of mothers and newborns. This commentary describes the importance of standardization, checklist use, auditing and feedback, peer coaching, and interdisciplinary communication as strategies to reduce risks. The discussion spotlights the need for national guidelines and definitions to reduce variation in auditing and training activities and calls for heightened engagement of health care professionals to improve the safety and quality of obstetric care in Canada. An Annual Perspective reviewed work on improving maternal safety.

… Journal of graduate medical education … J Grad Med Educ … This survey study examined remote …

Among hospitalized patients, adverse drug events (ADEs) are a common and serious source of patient harm. Medication reconciliation at the time of hospital admission reduces preventable ADEs and is a National Patient Safety Goal. In this three-arm, nonblinded, randomized controlled trial, researchers compared pharmacist or pharmacy technician–performed medication reconciliation before admission orders were placed to usual care among patients with at least 10 medications. Pharmacist and technician reconciliation led to similarly large decreases in minor and life-threatening medication order errors. Although pharmacist-led reconciliation reduces in-hospital ADEs in research settings, real-world implementation has been more challenging. Previous WebM&M commentaries highlight the dangers of inadequate medication reconciliation in inpatient and outpatient settings.

… Journal of clinical pathology … J Clin Pathol … Second opinions can shed light on challenging …

Disclosure of medical errors is a recommended patient safety practice. This focus group study of pathologists found that most pathologists believe treating clinicians should disclose pathology errors and express concern that treating clinicians do not understand the inherent limitations of pathologic diagnosis. The authors suggest that developing consensus guidelines may improve disclosure of pathology errors.

Hospitals with high readmission rates face reductions in Medicare reimbursements. Understanding the patient perspective at the time of readmission may better inform future readmission reduction efforts. Researchers surveyed patients readmitted to the general medicine services within 30 days of discharge across 12 hospitals on multiple aspects of self-care. Although 91% of patients reported understanding of their discharge plan, more than 52% reported difficulty with at least one aspect of self-care after discharge.

This study found that eliciting second opinions in pathology improved the accuracy of breast histopathology specimens. This work provides further evidence that diagnostic accuracy can be enhanced with second opinions. The authors suggest that implementing multiple clinician review may augment the diagnostic process.

… approach as a way to engage patients in safety efforts. … Bell SK, Mejilla R, Anselmo M, et al. When doctors share …

Severe hospital-acquired pressure ulcers are considered a never event, and they result in loss of payment for the hospitalization according to Centers for Medicare and Medicaid Services (CMS) policy. Bundled interventions have shown success at preventing these complications in research studies, but broader data on their effectiveness have been lacking. This study used administrative data to demonstrate that adoption of evidence-based strategies and implementation of the CMS policy was associated with a decrease in the incidence of hospital-acquired pressure ulcers in academic medical centers.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … This study measured the potential of …

Microscopic review of biopsy tissue is considered the gold standard for diagnosis of cancer and other diseases, but prior research has shown a small yet consistent rate of errors in cancer diagnosis that is attributable to misinterpretation of biopsy specimens. This study sought to quantify error rates in breast cancer diagnosis by having a broad sample of pathologists review a standardized set of biopsies whose diagnoses had been established by expert clinicians. Although biopsies with cancer were diagnosed very accurately, specimens with atypia (abnormal tissue that may be pre-cancerous) had substantial variability, with pathologists tending to overdiagnose these specimens (i.e., ascribe a diagnosis of cancer or pre-cancerous lesions when the correct diagnosis was benign). The authors caution that the specimens used in this study were intentionally chosen to be relatively difficult to interpret, and this may have resulted in overestimating the error rate. A related editorial notes that while the overall rate of diagnostic error in this study was low, misdiagnosis of atypia does have important prognostic and treatment significance for women, and therefore pathologists should systematically consult with colleagues in difficult cases, and more advanced molecular diagnostic methods should be applied in order to reduce subjectivity in biopsy interpretation.

This commentary uses case examples to demonstrate how economic analysis may help inform efforts to improve the safety of diagnostic decision making.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … Clinical decision support system … a consortium to maintain this list over time. Dr. David Blumenthal discusses DDI alert fatigue and other issues …

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … The impact of clinical decision …