The effective use of resources through stewardship initiatives can support error reduction through focusing actions of care. This commentary discusses how diagnostic stewardship can enhance diagnostic testing behaviors across the diagnostic process.

Children with complex home care needs are vulnerable to medication errors. This guideline suggests strategies to enhance medication safety at home that include focusing on health literacy, prescriber actions, dosing tool appropriateness, communication, and training of caregivers. 

Provider and patient underestimation of harms of tests and treatments may lead to over treatment. This article presents seven domains of harm of tests and treatment which warrant comprehensive research: (1) physical impairment, (2) psychological distress, (3) social disruption, (4) disruption in connection to healthcare, (5) labeling, (6) financial impact, and (7) treatment burden. Research is especially important in vulnerable patient populations.

Medical device-associated errors are common and often result in preventable patient harm. Based on medical device adverse event data reported to the FDA's Manufacturer and User Facility Device Experience (MAUDE), this study used natural language processing to identify events not classified as deaths even though the patient died. Findings suggest that approximately 17% of medical device events that resulted in death were classified in other categories.

Overdiagnosis is an emerging safety concern due to its potential to result in physical, financial, and emotional harm. Researchers surveyed 533 primary care practitioners (physicians, nurse practitioners, and physician assistants) and asked them to estimate the probability of disease for common conditions (pneumonia, cardiac ischemia, breast cancer screening, and urinary tract infection) and the association of positive and negative test results with disease probability. Findings indicate that significant overestimation of disease among all participating practitioners – likely due to overestimates of pretest probability – may contribute to overdiagnosis and overuse.

Medical overuse is a well-recognized patient safety challenge. This review expands upon prior research highlighting the top 10 studies published in 2018 that may help reduce overuse in pediatrics. Highlighted articles describe both established practices that may warrant deimplementation (such as routine outpatient opioid prescribing) and emerging practices that merit greater inspection or discouragement from widespread adoption (such as post-discharge nurse-led home visits).

… JAMA Intern Med … Medical overuse  has been described as a patient safety problem among both adult and  pediatric … and have the potential to cause  harm  to patients. … Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2019 Update on Medical …

Overuse of medical care represents a significant patient safety challenge. In this review, researchers highlight the top 10 studies published in 2017 that they suggest may help reduce overuse in pediatrics.

This retrospective cohort study found that opioid-naive adolescents who received an opioid prescription from a dentist were more likely to receive a subsequent opioid prescription or be diagnosed with an opioid use disorder compared to opioid-naive adolescents who did not receive an opioid prescription from a dentist. This finding is consistent with prior studies in adults, demonstrating increased risk of subsequent opioid use following short-term prescriptions. The authors urge caution in prescribing opioids to adolescents.

Overuse of medical care has been identified as a patient safety issue, but most existing literature focuses on overuse in adult patients. This review of literature published in 2017 identified 8 high-quality studies documenting overuse of diagnostic testing and therapeutics as well as overmedicalization of self-limited conditions in pediatric patients. The authors judged these examples of overuse to have significant potential for harming patients.

Health care overuse has been recognized as a potential contributor to patient harm. This commentary suggests that the problem of medical overuse begins in childhood and advocates for efforts to reduce overuse that focus on pediatric care. A recent WebM&M commentary discussed risks related to overdiagnosis and medical overuse.

Problems managing laboratory tests can contribute to diagnostic error. This commentary suggests that adjusting the diagnostic testing process could enhance the reliability of antibiotic use, reduce potential for unintended harms associated with overtesting, and improve care safety.

… J Interprof Care … J Interprof Care … Interprofessional … describes how one institution designed and implemented a multidisciplinary course to educate learners about core … error reporting . … Thom KA, Heil EL, Croft LD, Duffy A, Morgan DJ, Johantgen M. Advancing interprofessional patient …

Overuse of CT scans can expose patients to levels of radiation linked to increased rates of cancer. Describing efforts to raise awareness of problems associated with using medical imaging in children, this commentary calls for more targeted work to standardize the process for this population to reduce overuse to ensure safer care for pediatric patients.

… Journal of patient safety … J Patient Saf … Incident reporting is widely implemented to … educational intervention with resident physicians led to a significant increase in incident reports. The authors …

Shared decision-making is critical to high quality care and requires that providers accurately communicate risks and benefits of potential treatment options and tests to patients. This study surveyed residents and attendings regarding the rates of benefits and harms associated with routine medical interventions, their confidence in responses, use of statistical terminology when counseling patients on treatment options, and awareness of high-value campaigns. Investigators found that regardless of level of training, physicians overestimated both the harms and benefits of tests and treatments. Results also showed that most physicians did not use statistical terminology when explaining options to patients.

Contact precautions are essential to preventing the spread of health care–associated infections. Health care workers visit patients on contact precautions less often, and this has raised concerns about reduced vigilance increasing the risk of adverse events. This case-control study found that patients on contact precautions were actually less likely to experience noninfectious adverse events, allaying concerns about unintended consequences.

… America … Clin Infect Dis … Glove and gown precautions are a cornerstone of infection control in hospital settings. …

This expert guidance provides recommendations to help hospitals develop policies to reduce the spread of health care–associated infections by individuals visiting patients in isolation. The authors discuss contact precautions and outline specific conditions where these suggestions should be employed.