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Mirarchi FL, Cammarata C, Cooney TE, et al. J Patient Saf. 2021;17(6):458-466.
Prior research found significant confusion among physicians in understanding Physician Orders for Life-Sustaining Treatment (POLST) documents, which can lead to errors. This study found that emergency medical services (EMS) personnel did not exhibit adequate understanding of all POLST or living will documents either. The researchers propose that patient video messaging can increase clarity about treatment, and preserve patient safety and autonomy.
Korenstein D, Harris RP, Elshaug AG, et al. J Gen Intern Med. 2021;36(7):2105-2110.
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.
Blum MR, Sallevelt B, Spinewine A, et al. BMJ. 2021;374:n1585.
Older adults with multimorbidity and polypharmacy are at increased risk of adverse drug events. This cluster randomized controlled trial compared drug-related hospitalization rates of older adults who received a structured deprescribing intervention and those who received usual care. While rates of polypharmacy decreased, there was no effect on drug-related hospitalizations.
Bulliard J‐L, Beau A‐B, Njor S, et al. Int J Cancer. 2021;149(4):846-853.
Overdiagnosis of breast cancer and the resulting overtreatment can cause physical, emotional, and financial harm to patients. Analysis of observational data and modelling indicates overdiagnosis accounts for less than 10% of invasive breast cancer in patients aged 50-69. Understanding rates of overdiagnosis can assist in ascertaining the net benefit of breast cancer screening.
Sajid IM, Parkunan A, Frost K. BMJ Open Quality. 2021;10(3):e001287.
Inappropriate use or overuse of clinical tests such as MRIs can be harmful to patients. This cohort study, including 107 general practitioners across 29 practices, found that only 4.9% of musculoskeletal MRIs were clearly indicated and only 16.7% of results appeared to be correctly interpreted by clinicians, suggesting the potential for significant misdiagnosis and overdiagnosis.
Scott IA, Hubbard RE, Crock C, et al. Intern Med J. 2021;51(4):488-493.
Sound critical thinking skills can help clinicians avoid cognitive biases and diagnostic errors. This article describes three critical thinking skills essential to effective clinical care – clinical reasoning, evidence-informed decision-making, and systems thinking – and approaches to develop these skills during clinician training.
Green AR, Aschmann H, Boyd CM, et al. JAMA Netw Open. 2021;4(4):e212633.
Effective communication between patient and provider is key to successful deprescribing.  Participants in this study were asked to rate potential phrases a clinician may use to explain why stopping or reducing a medication is important. The most preferred phrase involved an explanation of risk of side effects associated with the medications while the least preferred options focused on the effort involved in taking the medication and “this medication is unlikely to help you function better”. Understanding the patient’s priorities can help frame the conversation around deprescribing.
Holmqvist M, Thor J, Ros A, et al. BMC Health Serv Res. 2021;21(1):557.
Polypharmacy in older adults puts them at risk for adverse drug events. In interviews with primary care clinicians, researchers found that working conditions and working in partnership with colleagues, patients, and family influenced medication evaluation. They also identified two main areas of action: working with a plan and collaborative problem-solving. 
Shafiee Hanjani L, Hubbard RE, Freeman CR, et al. Intern Med J. 2021;51(4):520-532.
Cognitively impaired older adults living in residential aged care facilities (RACF) are at risk of adverse drug events related to potentially inappropriate polypharmacy. Based on telehealth visits with 720 RACF residents, 66% were receiving polypharmacy, with cognitively intact residents receiving significantly more medications than cognitively impaired residents. Overall, 82% of residents were receiving anti-cholinergic medications which should be avoided in this population. Future interventions and research should pay particular attention to the prescribing of these medications.

The Society for Post-Acute and Long-Term Care Medicine.

Polypharmacy is a known challenge to patient safety. This collective program encourages long-term care organizations, physicians, and pharmacists to take part in a learning network to share aggregated data, lessons learned, and educational opportunities to reduce medication adverse events through safe deprescribing. 
Chalmers K, Smith P, Garber J, et al. JAMA Netw Open. 2021;4(4):e218075.
Overtreatment and overuse of healthcare services have been identified as potential sources of patient harm. Using Medicare fee-for-services claims, this study sought to describe hospital characteristics associated with 12 low-value services. Results showed the highest levels of overuse were associated with nonteaching and for-profit hospitals, particularly in the American South. The authors suggest interventions to decrease overuse and overtreatment could be targeted based on hospital characteristics and region.
Morgan DJ, Pineles L, Owczarzak J, et al. JAMA Intern Med. 2021;Epub Apr 5.
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.
Hahn EE, Munoz-Plaza CE, Lee EA, et al. J Gen Intern Med. 2021;Epub Jan 21.
Older adults taking potentially inappropriate medications (PIMs) are at increased risk of adverse events including falls. Patients and primary care providers described their knowledge and awareness of risk of falls related to PIMs, deprescribing experiences, and barriers and facilitators to deprescribing. Patients reported lack of understanding of the reason for deprescribing, and providers reported concerns over patient resistance, even among patients with falls. Clinician training strategies, patient education, and increased trust between providers and patients could increase deprescribing, thereby reducing risk of falls. 
Brownlee SM, Korenstein D. BMJ. 2021;372:n117.
Overuse of healthcare services can result in financial, physical, and emotional harm to the patient. If patients and clinicians better understood the risk of potential harms due to overuse, preventable harms may be reduced. Research is needed to quantify harm resulting from overuse of healthcare services, including the number of patients harmed and how serious the harms are.  

Issue Brief. Washington DC: Pew Charitable Trust; March 2021.

Antibiotic overuse is a contributor to nosocomial infection. This report discusses problems associated with antibiotic prescribing during the first 6 months of the COVID-19 pandemic. Systemic problems arising from the situation include disparities associated with antibiotic administration and unneeded receipt of medications by some patients.
Fudge N, Swinglehurst D. BMJ Open. 2021;11(2):e042504.
Polypharmacy – particularly in older adults – can increase the risk of adverse drug events. Based on an ethnographic case study of community pharmacies in England, the authors found that polypharmacy was a pervasive problem but rarely discussed as a safety concern and not actively challenged by pharmacy staff.

Jørgensen IF, Brunak S. NPJ Digital Med. 2021;4(1):12.

Overdiagnosis is a growing area of concern within patient safety. The authors present a generalizable approach for identifying patients at risk of being mis- or overdiagnosed. Using chronic obstructive pulmonary disease (COPD) patients as an example, the authors outline how to create significant, temporal disease trajectories, and compare similarities between these disease trajectories and individual patient disease histories to identify the cases that may signal overdiagnosis.
Dellinger JK, Pitzer S, Schaffler-Schaden D, et al. BMC Geriatr. 2020;20(1):506.
Polypharmacy in older adults is common and may increase risk of medication-related adverse events. This study found that an intervention combining educational training, tailored health information technology, and a therapy check process improved medication appropriateness in nursing home residents.