The emergency department is considered a high-risk setting for diagnostic errors. This analysis of Medicare claims data found that a significant number of adults age 65–89 died within a week of visiting and being discharged from an emergency department, even when no life-limiting illness was noted. Hospitals that admit a lower proportion of emergency department patients to the inpatient setting had a higher mortality rate among discharged patients, even after adjusting for patient characteristics. Consistent with prior studies relating patient outcomes to volume, higher-volume emergency departments had lower 7-day mortality among discharged patients. These results suggest that emergency department discharges may represent missed diagnoses. A WebM&M commentary discussed an incident involving a patient who died after being discharged from the emergency department.

… chronic pain safely in this high-risk population. A WebM&M commentary described risks related to prescribing opioids …

This study discovered that implementation of computerized physician order entry (CPOE) systems is a greater reflection of hospital ownership and teaching status than hospital profitability. Using Leapfrog survey data derived from their efforts to reward CPOE adoption, investigators present findings from hospitals with varying degrees of operational CPOE systems. While many have argued that limitation in resources prevents wider implementation, these findings counter those explanations. Interestingly, government hospitals represented the most likely adopters and for-profit organizations the least likely, adding to the notion that these systems are not intended to provide significant profits. Findings suggest that other factors, such as caring for the sickest patients or political interests in safety, may partly explain the results. The authors express concern that less than 5% of hospitals are in compliance with CPOE standards and that changes in the reimbursement environment through federal initiatives may provide necessary stimulus.