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Khidir H, McWilliams JM, O’Malley AJ, et al. JAMA Netw Open. 2021;4(9):e2125193.
While racial, ethnic, and gender biases have been widely documented at the system level, it has not been well documented at the individual physician level. This analysis of 4.5 million emergency department visits in the US showed variation in hospital admission rates among physicians, but an individual physician’s propensity to admit patients did not vary by patient sociodemographic group.
US Food and Drug Administration. October 7, 2021.
Errors of commission during complex procedures can contribute to patient harm. Drawing from an analysis of medical device reports submitted to the Food and Drug Administration, this updated announcement seeks to raise awareness of common adverse events associated with surgical staplers and implantable staples. User-related problems include opening of the staple line, misapplied staples, and staple gun difficulties. Recommendations include ensuring availability of various staple sizes and avoiding use of staples on large blood vessels.
Bosson N, Kaji AH, Gausche-Hill M. Prehosp Emerg Care. 2021;Epub Jul 14.
Pediatric medication administration in prehospital care is challenging due to the need to obtain an accurate weight and calculate dosing. The Los Angeles County emergency medical services implemented a Medical Control Guideline (MCG) to eliminate the need to calculate the dose of a commonly administered medication. Following implementation of the MCG, dosing errors decreased from 18.5% to 14.1% in pediatric prehospital care.
Fernández‐Aguilar C, Martín‐Martín JJ, Minué Lorenzo S, et al. J Eval Clin Pract. 2021;Epub Aug 11.
Heuristics, or the use of mental shortcuts based on experience or trial and error that allow clinicians to quickly assess or diagnose a problem, can sometimes result in misdiagnosis. Three types of heuristics are explored in this study of primary care diagnostic error: representativeness, availability, and overconfidence. While a diagnostic error was identified in nearly 10% of cases, there was no significant correlation between the use of heuristics and diagnostic error.

This case describes multiple emergency department (ED) encounters and hospitalizations experienced by a middle-aged woman with sickle cell crisis and a past history of multiple, long admissions related to her sickle cell disease. The multiple encounters highlight the challenges of opioid prescribing for patients with chronic, non-cancer pain.

A 44-year-old man presented to his primary care physician (PCP) with complaints of new onset headache, photophobia, and upper respiratory tract infections. He had a recent history of interferon treatment for Hepatitis C infection and a remote history of cervical spine surgery requiring permanent spinal hardware. On physical examination, his neck was tender, but he had no neurologic abnormalities. He was sent home from the clinic with advice to take over-the-counter analgesics.

Kim S, Goelz L, Münn F, et al. BMC Musculoskelet Disord. 2021;22(1):589.
Late diagnosis of upper extremity fractures can lead to delays in treatment. When two radiologists reviewed whole-body CT scans, each missed known fractures and identified previously unknown fractures. Slice thickness was not significantly associated with missed fractures; however, missed and late diagnosis occurred more often between the hours of 5pm and 1am.
Barber Doucet H, Ward VL, Johnson TJ, et al. Clin Pediatr (Phila). 2021;60(9-10):408-417.
Healthcare provider implicit biases can lead to inequitable care delivery and poorer patient outcomes. Pediatric residents were surveyed about their attitudes, skill level, and preferred educational interventions related to implicit bias and care of diverse populations. Prior medical education or training in diversity and bias-related skills was associated with higher self-reported skill level.
D'Angelo JD, Lund S, Busch RA, et al. Surgery. 2021;170(2):440-445.
This study evaluated the type and effectiveness of resident and faculty coping strategies following an intraoperative error and the interaction with physician gender. Results show that while men and women surgeons experience adverse events at approximately the same rate, the coping methods utilized and effectiveness of the methods varied.
Jagneaux T, Caffery TS, Musso MW, et al. J Patient Saf. 2021;17(6):425-429.
Emergency and internal medicine residents attended a course on central venous access that included lectures, videos, and simulation using a task trainer. Comparison of pre- and post-training evaluation demonstrated significant improvement in knowledge, confidence, and procedural skills.

Ellis NT, Broaddus A. CNN. August 25, 2021. 

Maternal safety is an ongoing challenge worldwide. This news feature examines how the COVID pandemic has revealed disparities and implicit biases that impact the maternal care of black women. The stories shared highlight experiences of mothers with preventable pregnancy-related complications.
Searns JB, Williams MC, MacBrayne CE, et al. Diagnosis (Berl). 2021;8(3):347-352.
This study leveraged “Great Catches” as part of an existing handshake antimicrobial stewardship program (HS-ASP) to identify potential diagnostic errors. Using a validated tool, researchers found that 12% of “Great Catch” cases involved diagnostic error. These cases included a diagnostic recommendation from the HS-ASP team (e.g., recommendations to consider alternative diagnoses, request additional testing, or additional interpretation of laboratory results). As these diagnostic recommendations often flagged diagnostic errors, this suggests that the HS-ASP model can be leveraged to identify and intervene on diagnostic errors in real time.

A 31-year-old woman presented to the ED with worsening shortness of breath and was unexpectedly found to have a moderate-sized left pneumothorax, which was treated via a thoracostomy tube. After additional work-up and computed tomography (CT) imaging, she was told that she had some blebs and mild emphysema, but was discharged without any specific follow-up instructions except to see her primary care physician.

Fatemi Y, Coffin SE. Diagnosis (Berl). 2021;Epub Aug 5.
Using case studies, this commentary describes how availability bias, diagnostic momentum, and premature closure resulted in delayed diagnosis for three pediatric patients first diagnosed with COVID-19. The authors highlight cognitive and systems factors that influenced this diagnostic error.
Park J, Saha S, Chee B, et al. JAMA Netw Open. 2021;4(7):e2117052.
The patient-provider relationship plays an important role in the delivery of safe, quality health care.  Using electronic encounter notes, this qualitative study describes physician language used to express negative and positive attitudes toward the patient. While positive attitudes were generally expressed via explicit language (e.g., direct compliments), negative attitudes were not explicit and often expressed through questioning patient credibility, disapproval of patient reasoning or self-care, stereotyping, portraying the patient as difficult, and emphasizing physician authority over the patient.
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.

A 61-year-old male was admitted for a right total knee replacement under regional anesthesia. The surgeon – unaware that the anesthesiologist had already performed a right femoral nerve block with 20 ml (100mg) of 0.5% racemic bupivacaine for postoperative analgesia – also infiltrated the arthroplasty wound with 200 mg of ropivacaine. The patient was sedated with an infusion of propofol throughout the procedure.