Lagisetty P, Macleod C, Thomas J, et al. Pain. 2021;162:1379-1386.
Inappropriate prescribing of opioids is a major contributor to the ongoing opioid epidemic. This study involved simulated patients with chronic opioid use who called primary care clinics in need of a new provider because their previous physician had retired or stopped prescribing opioids. Findings indicate that primary care providers were generally unwilling to prescribe opioids to patients whose histories are suggestive of misuse, which may raise access to care concerns and cause potential unintended harm for some patients.
Ferrara G, De Vincentiis L, Ambrosini-Spaltro A, et al. Am J Clin Pathol. 2021;155:64-68.
The COVID-19 pandemic has led to patients delaying or forgoing necessary health care. Comparing the same 10-week period in 2018, 2019 and 2020, researchers used data from seven hospitals in northern-central Italy to assess the impact of COVID-19 on cancer diagnoses. Compared to prior years, cancer diagnoses overall fell by 45% in 2020. Researchers noted the largest decrease in cancer diagnoses among skin, colorectal, prostate, and bladder cancers.
Gillies D, Chicop D, O'Halloran P. Crisis. 2015;36:316-324.
This study used root cause analysis to identify underlying causes of suicide among mental health service clients. Researchers found that most patients had denied suicidal ideation and had missed follow-up in their mental health care. Their results underscore the challenge of preventing suicide in patients with mental illness.
In response to a recent investigation raising concerns about inaccurate reporting of wait-time data, this commentary relates barriers to improving patient safety, such as overuse of performance measures. The authors describe approaches to augment safety, such as narrowing down performance measures to address the most significant concerns and engaging private health care organizations in improvement projects.
Rivera-Rodriguez AJ, Karsh B-T. Qual Saf Health Care. 2010;19:304-312.
The majority of individual errors are due to failure to perform automatic or reflexive actions. A major risk factor for these "slips" is being interrupted or distracted while performing a task. This review examined the literature on the incidence, risk factors, and effects of interruptions in several clinical settings, ranging from outpatient clinics to the operating room. Although distractions are common and may be associated with increased risk for error, particularly if they occur during medication administration or signout, the authors point out that many interruptions may be necessary to communicate urgent clinical information. They argue for complexity theory–based research to delineate the harmful and beneficial aspects of interruptions, rather than for interventions that seek to simply eliminate interruptions. Checklists have been widely adopted as a means of preventing errors of omission, which may be precipitated by interruptions.
Pandhi N, Schumacher J, Flynn KE, et al. Health Expect. 2008;11:400-8.
Discontinuity is an unfortunate but inevitable reality of medical care, as no clinician can be available around the clock. This study surveyed geriatric patients to examine patients' perceptions of discontinuity in the outpatient setting. Although a relatively small proportion of patients reported that they would feel unsafe if seeing someone other than their primary physician, those who did report concerns tended to have more complex medical problems. This feeling may be well founded, as a recent study documented that communication between providers caring for the same patient is often poor. The safety effects of discontinuity have been most studied in the hospital, and strategies have been developed to improve the transmission of information between inpatient providers.
Allan J, Ball P, Alston M. Rural Remote Health. 2008;8:835.
Drawing from qualitative interviews with pharmacists and social workers, investigators determined that access to rural health services is affected by individual concerns about privacy and confidentiality, and by the reputation and value system of the health care worker.
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