Researchers describe two types of decision making in medicine - fast (intuitive) and slow (analytical). While both types are subject to bias, this paper describes how cognitive biases in fast thinking, such as anchoring or framing, as well as racial or moral bias, can result in obstetrical misdiagnosis. Ten steps to mitigate these cognitive biases are laid out.

Ensuring the safety of clinical trial participants is paramount to successful, meaningful clinical research. In this study, researchers examined 585 clinical trial documents and found that 17% included potential patient safety interventions (e.g., resolving medication dosing discrepancies). The authors suggest that clinical specialists’ review of study protocol documents could enhance patient safety during clinical trial conduct.

… Jt Comm J Qual Patient Saf … In the United States , women and …

Diagnostic errors in pediatrics remain a significant focus of patient safety. This study uses two years of unplanned readmissions to a children’s hospital to identify missed opportunities for improving diagnosis (MOID). Clinician decision-making and diagnostic reasoning were identified as key factors for MOID. The authors recommend that future research include larger cohorts to identify populations and conditions at increased risk for MOID-related readmissions.

… J Patient Saf … High-risk opioid prescribing can increase the … and less patient-reported discharge pain. … Rennert L,  Howard KA, Walker KB, et al. Evaluation of policies limiting … elective surgery in a large American health system. J Patient Saf. 2023;19(2):71-78. 10.1097/pts.0000000000001088 …

Opioid overdose and misuse continues to be a major public health concern with numerous policy- and organization-level approaches to encourage appropriate clinician prescribing. A northern California health system studied the effects of three interventions (individual audit feedback, peer comparison, both combined) as compared to usual care at several emergency department and urgent care sites. Peer comparison and the combined interventions resulted in a significant decrease in pills per prescription.

With the goal of improving allocation of scarce care coordination resources in primary care, this study utilized Medicare fee-for-service claims data to identify risk factors to identify individuals at risk of future avoidable hospital events. Risk factors in six domains were identified: diagnosis, pharmacy utilization, procedure history, prior utilization, social determinants of health, and demographic information.

Computerized prescriber (or physician) order entry (CPOE) systems are widely used in healthcare and studies have shown a reduction in medication errors with CPOE. This study focused on whether CPOE systems improved the incidence of chemotherapy-related medication errors. The study included 11 studies in the review but only 8 studies were in the meta-analysis. The authors found that the use of CPOE was associated with an 81% reduction in chemotherapy-related medication errors, indicating that CPOE is a valuable strategy for this patient population.

This nationwide survey of U.S. adults found that many respondents (40.9%) have avoided routine, urgent and emergent medical care during the COVID-19 pandemic. Avoidance of urgent or emergency care was significantly higher among unpaid caregivers for adults; persons with underlying medical conditions; persons with health insurance; non-Hispanic Black, Hispanic, or Latino adults; young adults; and persons with disabilities.

Failure to speak up and raise concerns in the clinical environment can adversely impact patient safety. In this randomized controlled trial, simulation-based education provided to postpartum and labor and delivery nurses in the intervention arm was not associated with a difference in speaking-up scores as compared to those in the control group overall.

… data in order to make opioid prescribing safer . … Howard R, Fry B, Gunaseelan V, et al. Association of Opioid …

Improving diagnosis remains a major focus within patient safety. For patients with rare diseases, diagnosis can often be delayed. Established in 2014 and funded by the National Institutes of Health, the Undiagnosed Diseases Network (UDN) applies a multidisciplinary approach to the most challenging diagnostic cases. Over a 20-month period, 601 out of 1519 patient cases were accepted by the UDN for evaluation. The authors report that of the 382 patients who underwent a complete evaluation, a diagnosis was identified in 132 patients.

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … Emergency manuals have been adopted from …

… J Am Heart Assoc … J Am Heart Assoc … Though electronic health record (EHR) data …

This pre–post study examined the effect of implementing an evidence-based opioid prescribing guideline following cholecystectomy surgery. After guideline implementation, the average number of opioid pills per prescription declined, but no increase in refill requests occurred. More patients were prescribed nonopioid pain medications after guideline implementation than before. These promising results suggest a path toward reducing the use of these high-risk medications.

Overlapping surgery refers to the practice of surgeons scheduling two procedures performed on different patients concurrently. This practice has raised safety concerns in light of news investigations, which prompted a government inquiry into concurrent surgery policies. This single-center retrospective study of 2275 neurosurgery cases at an academic medical center compared overlapping to nonoverlapping procedures. The majority of surgeries were overlapping, and rates of morbidity and mortality did not differ between overlapping and nonoverlapping cases. These findings suggest that overlapping surgery can be conducted safely.