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Using data from a large, national private insurance provider including 134 million opioid prescription claims, this study characterized prescribing patterns from 2003-2017. In 2017, the top 1% of opioid providers prescribed 27% of all opioid prescriptions and accounted for nearly half (49%) of all opioid doses. A large proportion of prescriptions written by high prescribing opioid providers exceeded guidelines for recommended dosing levels and length. In contrast, the majority of prescriptions for the bottom 99% of prescribers met prescribing guidelines. The authors conclude that broad interventions focused on enforcing prescribing thresholds are likely be ineffective since most providers are prescribing within guidelines. Instead, interventions to reduce inappropriate prescribing should be tailored towards the top 1% of opioid prescribers and their patients, and should focus on improving the supportive management of patients with complex pain and addressing associated comorbidities.

Unintended consequences can emerge when targeted strategies divert attention from concurrent safety concerns. This editorial recommends that lessons learned during efforts to improve opioid prescribing should be employed to reduce the potential for overprescription and misuse of benzodiazepines.

This prospective cohort study found that many outpatients treated at a chronic pain clinic were willing to voluntarily taper opioid medications. Although nearly 40% of patients dropped out of the study, those that remained significantly reduced their opioid dosing. The authors suggest that offering a voluntary gradual opioid taper to patients with chronic pain may reduce their opioid dose.

Concurrent use of opioids and benzodiazepines increases risk for adverse drug events. This retrospective analysis of medical claims found that the risk of emergency department visit was greater for patients with concurrent use of these two medication classes compared to patients on opioids alone. This finding supports the recommendation to avoid coprescribing these two medication classes.

The AHRQ Patient Safety Indicators (PSIs) do not include adverse events after hospital discharge, which could introduce bias into measurement of safety events at the individual hospital level. However, this study found that inclusion of postdischarge adverse events in PSI calculations did not significantly change comparisons of safety between hospitals or within the same hospital over time.

This study provides a link between safety climate and organizational culture demonstrating that measured safety climate is better in settings with less hierarchy and greater group participation.

Hospitals with superior overall patient safety culture measurements also had lower rates of potential safety problems (as measured by the Agency for Healthcare Research and Quality's Patient Safety Indicators). However, the relationship between safety climate and patient outcomes was not consistent across all dimensions of safety culture.

This survey found significant differences in perceived safety culture between clinical areas, with emergency department staff having the least positive impressions. A prior study using the same survey also found variations in safety culture by management level.

Establishing a culture of safety, in which workers at all levels are encouraged to report errors, openly discuss mistakes, and contribute to solutions, is thought to be essential to improving patient safety. However, prior research has documented that perceptions of safety culture may vary widely between clinical units and provider levels. This study administered a previously validated safety culture survey to managers at 92 US hospitals, and found that perceptions of safety culture varied even among managers at different levels. As documented in prior research, more senior managers generally had better perceptions of safety than did lower-ranking managers. Impaired safety culture has been implicated as a factor in high-profile errors in health care and other industries.

This study describes the development of the Patient Safety Climate in Healthcare Organizations survey, a novel instrument for evaluating organizational culture of safety. The authors grouped the survey questions into nine dimensions of safety, including organizational factors, work unit factors, and individual factors. The instrument was tested on more than 20,000 health care workers and proved to have good reliability. A prior systematic review discussed the strengths and weaknesses of other existing safety culture surveys. Thus far, only the Safety Attitudes Questionnaire has demonstrated a link between perceptions of safety culture and safety outcomes.

This AHRQ-funded study describes the association between dimensions of effective quality improvement (QI) and their impact on hospital-based patient safety indicators (PSI). Investigators combined data from a national survey of hospital QI practices with four PSIs in demonstrating that physician involvement in QI was the only significant association with improved indicator scores. Involvement of senior management and multiple hospital units in a QI effort failed to demonstrate a significant association with PSI values. This study expands on previous efforts at understanding the organizational factors involved in achieving patient safety improvement.