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Clayton DA, Eguchi MM, Kerr KF, et al. Med Decis Making. 2022;Epub Sep 20.
Metacognition (e.g., when one reflects on one’s own decision and decision making) is an approach to reducing diagnostic errors. Using data from the Melanoma Pathology Study (M-PATH) and Breast Pathology Study (B-PATH), researchers assed pathologists’ metacognition by examining their diagnostic accuracy and self-confidence. Results showed pathologists with increased metacognition sensitivity were more likely to request a second opinion for incorrect diagnosis than they were for a correct diagnosis.
Hunter J, Porter M, Williams B. Australas Emerg Care. 2022;Epub Aug 29.
Situational awareness (SA) requires recognizing situations, interpreting them, and predicting how the situation may unfold in the future. Paramedics and emergency medical technicians (EMT) participated in a video simulation to assess their SA at each of the three stages. Quantitative results indicated the providers were not situationally aware during the simulation.
Fuller AEC, Guirguis LM, Sadowski CA, et al. Sr Care Pharm. 2022;37:421-447.
While barcode-assisted medication administration (BCMA) and electronic medication administration records (eMAR) technologies have reduced adverse drug events, workarounds that may contribute to medication errors have been identified for both. This study of medication administration errors was conducted in a Canadian long-term care facility following implementation of eMAR-BCMA software. During the twenty-nine-month study period, 190 medication administration errors were reported.

Tahir D. Kaiser Health News. September 26, 2022. 

Negative patient representations in medical records perpetuate stereotypes that can affect care over time. This story discusses how written notes using stigmatizing language reflect bias and physician disrespect that serve as clues to misdiagnosis. Black patients and those patients named as "difficult" were particularly vulnerable to damaging representation in notes.

Rockville, MD: Agency for Healthcare Research and Quality; September 2022. AHRQ Publication No. 22-0026-3-EF.

Correct consideration of the likelihood that a patient may have a potential disease guides each level of diagnostic decision making; misjudgments can be fatal. This issue brief introduces an information-focused framework to examine how clinicians determine probability and discusses educational avenues for enhancing those skills. The publication is part of a report series on diagnostic safety.
FitzGerald C, Mumenthaler C, Berner D, et al. BMC Med Ethics. 2022;23:86.
Patients with obesity and mental illness face both explicit and implicit bias that negatively impact their healthcare. This study of psychiatric and general internal medicine physicians analyzed implicit and explicit bias towards patients with mental illness and/or obesity. Results varied by specialty, physician age, gender, and experience level.
Suneja M, Beekmann SE, Dhaliwal G, et al. Diagnosis (Berl). 2022;9:332-339.
Delayed diagnosis of infectious diseases can lead to serious patient harm. This survey of over 500 infectious disease clinicians revealed that diagnostic delay often involved diagnoses of infective endocarditis and epidural abscesses. Respondents identified several factors contributing to diagnostic delays including usual clinical presentations and the timing of infectious disease consultations.
Vecchione TM, Agarwal R, Monitto CL. Paediatr Anaesth. 2022;32:982-992.
Appropriate pediatric pain management is an ongoing patient safety concern. This article discusses five categories of errors in pediatric acute pain management and how mitigating cognitive biases can help clinicians anticipate, identify, and avoid these errors.
Shimizu T, Graber ML. Diagnosis (Berl). 2022;9:311-315.
Improving diagnostic reasoning skills can reduce diagnostic errors. These authors discuss how insight – or the spontaneous emergence of the correct answer at a later point in time – can be incorporated into the diagnostic process and approaches to nurturing insight through existing strategies (e.g., cognitive forcing functions, mnemonics) and enhancing both critical and creative thinking.  
Redelmeier DA, Shafir E. Med Decis Making. 2022;Epub Sep 5.
Premature closure occurs when clinicians accept a diagnosis before it has been confirmed and alternative diagnoses have been explored and can lead to missed diagnosis. In this study, participants (including both health care professionals and community members) were provided one of five scenarios describing a hypothetical patient with symptoms suggestive of COVID-19 in the presence or absence alternative diagnosis (e.g., COVID-19 symptoms and the presence or absence of a positive flu test). Findings suggest that bias can lead individual to overlook the likelihood of COVID-19 when an alternative diagnosis is present.
Ghaith S, Campbell RL, Pollock JR, et al. Healthcare (Basel). 2022;10:1328.
Obstetric and gynecologic (OB/GYN) physicians are frequently involved in malpractice lawsuits, some of which result in catastrophic payouts. This study categorized malpractice claims involving OB/GYN trainees (students, residents, and fellows) between 1986 and 2020. Cases are categorized by type of injury, patient outcome, category of error, outcome of lawsuit, and amount of settlement.
Wise J. BMJ. 2022;378:o1974.
Patients can be vulnerable to having concerns dismissed or being gaslighted as to their legitimacy. Implicit biases against women in both clinical and administrative settings are known to foster conditions for unsafe care. This piece defines the use of the term gaslighting and how it can result in diagnostic delay due to a lack of patient-centered communication and respect.
Apodaca C, Casanova-Perez R, Bascom E, et al. J Am Med Inform Assoc. 2022;Epub Aug 19.
Minoritized patients who experience implicit or overt discrimination in healthcare report receiving lower quality of care and may avoid seeking care in the future altogether. In this study, patients who identify as Black, Indigenous, People of Color (BIPOC), and/or Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) describe their experiences of unfair treatment and discrimination in healthcare. Four themes related to immediate reactions and six themes related to long-term coping emerged.
Yale SC, Cohen SS, Kliegman RM, et al. Diagnosis (Berl). 2022;9:348-351.
Diagnostic timeouts can improve the differential diagnosis process and limit missed diagnostic opportunities. This prospective study evaluated the implementation of diagnostic timeouts among eight pediatric hospital medicine providers over a 12-month period. In the majority of cases, the diagnostic timeout led to the pursuit of alternative diagnoses.
Kraemer KL, Althouse AD, Salay M, et al. JAMA Health Forum. 2022;3:e222263.
Nudges (e.g., default order sets) in the electronic health record (EHR) have been shown to encourage safer prescribing of opioids in emergency departments. This study evaluated the effect of nudges to reduce opioid prescribing for opioid-naïve patients with acute pain. Primary care practices were cluster randomized to control, opioid justification in the EHR, peer comparison, or combined opioid justification and peer comparison groups. The three intervention groups showed reduced opioid prescribing compared to control.
Hoffman S. J Med Regulation. 2022;108:19-28.
Patient safety advocates have called for cognitive testing of aging clinicians and some health systems have attempted instituting such policies as part of their recredentialing program. This commentary calls for state medical boards to adopt cognitive testing as part of the recredentialling process within the confines of legal boundaries.

A 65-year-old female with a documented allergy to latex underwent surgery for right-sided Zenker’s diverticulum. Near the conclusion of surgery, a latex Penrose drain was placed in the neck surgical incision. The patient developed generalized urticaria, bronchospasm requiring high airway pressures to achieve adequate ventilation, and hypotension within 5 minutes of placement of the drain. The drain was removed and replaced with a silicone drain. Epinephrine and vasopressors were administered post-operatively and the patient’s symptoms resolved.

A 49-year-old woman was referred by per primary care physician (PCP) to a gastroenterologist for recurrent bouts of abdominal pain, occasional vomiting, and diarrhea. Colonoscopy, esophagogastroduodenoscopy, and x-rays were interpreted as normal, and the patient was reassured that her symptoms should abate. The patient was seen by her PCP and visited the Emergency Department (ED) several times over the next six months. At each ED visit, the patient’s labs were normal and no imaging was performed.

AMA J Ethics. 2022;24(8):e715-e816.

Health inequity is recent expansion in the patient safety canon. This special issue examines poor access, quality of care, and health status as contributors to patient harm. Articles discuss race, gender, and ethnicity as factors generating unsafe experiences for patients.