Missed steps in the diagnostic process, such as timely referral for surgical consultation, can lead to missed or delayed diagnoses. This large, retrospective cohort study using Medicare data identified disparities between Black and White patients in receipt of consults for emergency surgery. Findings show that Black patients had lower odds of receiving a surgical consultation after being admitted from the emergency department; these disparities remained after adjusting for medical comorbidities, socioeconomic factors, and individual hospital-level effects.

Imaging is an important tool in the pediatric emergency department to guide diagnosis and treatment. In this study, researchers analyzed more than 3.6 million emergency department visits for patients younger than 18 years to evaluate racial and ethnic differences in diagnostic imaging rates. One-third of visits by non-Hispanic white children included imaging, compared with 24% of visits by non-Hispanic Black and 26% of Hispanic children. Given the risks of both radiation exposure and missed diagnoses, strategies to mitigate these disparities must be investigated.

The overprescribing of opioids for postsurgery pain can increase the potential for opioid dependence, misuse, and harm. Discussing this worldwide patient safety concern, this commentary summarizes clinician, patient, and systemic factors that contribute to the problem and outlines efforts to address the issue while enabling clinicians to provide safe pain therapy to patients.

This retrospective observation cohort study conducted at nine hospitals sought to determine whether discharge from the intensive care unit (ICU) directly to home affected odds of readmission within 30 days or mortality within 1 year. Overall, patients discharged from the ICU to home are younger and less ill than patients who are transferred from the ICU to the hospital ward before returning home. The proportion of patients discharged from ICU to home varied widely by site. When researchers compared patients discharged from ICU to home to patients of similar age and severity of illness upon ICU admission who were discharged home from the hospital ward, they found no differences in odds of readmission or mortality. A related commentary explores why discharges from ICU to home occur and calls for implementing care transitions best practices upon ICU discharge in order to support optimal patient outcomes and prevent readmissions.

In the Improving Diagnosis report, the National Academy of Medicine called for broad-scale efforts to reduce diagnostic errors. This retrospective cohort study employed natural language processing to identify dangerous diagnoses that pediatric emergency medicine physicians missed. A past WebM&M commentary laid out challenges in classifying diagnostic errors.

The large surge in opioid use is a serious patient safety problem. This retrospective study revealed that risk of postoperative inpatient opioid overdose increased over time. Patients with a substance abuse history were more likely to experience a postoperative opioid overdose, but hospital characteristics did not predict this complication. This finding suggests that high-risk patient characteristics should be taken into account in prescribing opioids after surgery.

Given increasing rates of overdose related to opioids, providers' prescribing behavior has come under greater scrutiny. Researchers examined opioid prescribing by dentists after surgical tooth extraction for a cohort of Medicaid patients and found significant variation in the amount of medication prescribed. They suggest that dental care should be one of the areas that is considered when implementing programs to decrease opioid use.

Harm related to opioid medications is rampant and growing. This data analysis revealed a very high prevalence of new opioid prescriptions following low-risk surgical procedures. The authors suggest that further studies examine an association between receiving opioids after a low-risk procedure and subsequent harm or addiction.

Discussing communication weaknesses in surgery, this commentary examines how team-based decision making can contribute to safer and more patient-centered care in this setting, particularly for complex cases. The authors advocate for an enhanced safety culture to support better communication.