Brady KJS, Barlam TF, Trockel MT, et al. Jt Comm J Qual Patient Saf. 2022;48:287-297.
Inappropriate prescribing of antibiotics to treat viral illnesses is an ongoing patient safety threat. This study examined the association between clinician depression, anxiety, and burnout and inappropriate prescribing of antibiotics for acute respiratory tract infections (RTIs) in outpatient care. Depression and anxiety, but not burnout, were associated with increased adjusted odds of inappropriate prescribing for RTIs.
Furlan L, Francesco PD, Costantino G, et al. J Intern Med. 2022;291:397-407.
Overtreatment and overuse can have unanticipated consequences, ranging from patient anxiety while awaiting test results to medical complications. The authors identify several factors that can contribute to patient overtreatment (fear of uncertainty, cognitive bias, applying low-quality evidence, and overfocusing on diagnosis). Interventions to overcome these issues include educating clinicians that uncertainty is a part of medicine and shifting to a focus on patient-centered management rather than focusing on identifying a diagnosis.
Shenoy A, Shenoy GN, Shenoy GG. Patient Saf Surg. 2022;16:10.
Defensive medicine refers to clinician behaviors with the intent to avoid malpractice risk due to care omissions. This article provides an overview of defensive medicine and its relationship to the taxonomies of medical errors and the risks that defensive medicine places on patients, hospital administrators, and systems, as well as clinicians.
Scott IA, Hubbard RE, Crock C, et al. Intern Med J. 2021;51:488-493.
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.
Morgan DJ, Pineles L, Owczarzak J, et al. JAMA Intern Med. 2021;181:747-755.
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.
Misdiagnosis can perpetuate over a long period and delay a correct course of treatment. This news feature shares an example of depression misdiagnosis that masked the true problem of a neurological tumor manifesting in what was seen and treated as a psychological condition.
Antibiotic overuse is a long-standing safety concern due to the potential global public health impact of the practice in supporting drug-resistant bacteria. This news article discusses the overprescribing of antibiotics in context of viral disease pandemics.
Second opinions are a strategy for reducing diagnostic or treatment errors. This article outlines reasons why patients seek additional expert opinion when determining a course of action and discusses non-clinical benefits of the practice.
Liu J, Kaye KS, Mercuro NJ, et al. Infect Control Hosp Epidemiol. 2019;40:206-207.
Never events are devastating to patients and indicate serious underlying organizational safety problems. This commentary suggests that there are types of inappropriate antibiotic use behaviors that should be categorized as never events, such as use of an antibiotic longer than is required. The authors believe that labeling these incidents as never events will drive development and application of prevention strategies.
Medical overuse can have negative ramifications for both patients and health care organizations. This commentary suggests that cognitive error is a key contributor to overuse. Rethinking evidence-based medicine education and improving physician skills in risk assessment and decision analysis can help reduce overuse. A PSNet perspective discussed medical overuse as a patient safety problem.
Overuse of tests and treatments can contribute to negative consequences for patients. This commentary suggests that clarification is required to engage clinicians in reducing overuse-related harm and proposes a six-domain framework that delineates areas of concern to target improvement strategies. A previous WebM&M commentary highlighted a case in which health care overuse resulted in a patient's death.
Overdiagnosis has emerged as a quality and safety concern due to its potential to result in financial and emotional harm for patients and their families. This review discusses factors that contribute to overdiagnosis in primary care including financial incentives and innovations in diagnostic technologies. The authors recommend increasing awareness about the negative consequences of unneeded screenings, clarifying the definition of overdiagnosis, and adjusting cultural expectations for testing and treatment as avenues for improvement.
Overdiagnosis and overtreatment can result in physical, financial, and emotional harm for patients. This commentary suggests applying quality improvement approaches to address overdiagnosis and overtreatment. Tactics discussed include clear articulation of the problem and contributing factors, use of theory-driven approaches for designing initiatives, and monitoring the impact of improvement efforts.
Overdiagnosis and overtreatment present a challenge to patient safety. This news article reports on the prevalence of overtreatment among patients with cancer, how it can result in patient harm, and patient stories that illustrate the impact of overtreatment. A past PSNet interview discussed the patient safety implications of diagnostic radiology overuse.
Overuse of medical care can lead to patient harm. In this survey study, physicians were queried about the overuse of health care as well as contributing factors and solutions. Fear of malpractice was cited as a major reason for overtreatment.
Aaron SD, Vandemheen KL, FitzGerald M, et al. JAMA. 2017;317:269-279.
Misdiagnosis can contribute to overuse of unnecessary medication and treatments as well as a delay in appropriate treatment, placing patients at increased risk of harm. This prospective cohort study suggests that asthma may be frequently misdiagnosed in the community setting as a result of inadequate testing for airflow limitations. In 2% of the cases analyzed, a serious underlying cardiorespiratory condition was misdiagnosed as asthma.
Jørgensen KJ, Gøtzsche PC, Kalager M, et al. Ann Intern Med. 2017;166:313-323.
The overuse of medical care is increasingly recognized as a patient safety issue. Overdiagnosis can result in unnecessary use of medical care, subjecting patients to greater risk of harm. For example, in the case of breast cancer, screening may detect lesions that are not clinically significant, leading to further testing and unnecessary procedures. This study examined the impact of mammography screening on a cohort of women in Denmark. Researchers found that screening was not associated with decreased incidence of advanced cancer but increased incidence of nonadvanced tumors and ductal carcinoma in situ; the rate of overdiagnosis was significant. An accompanying editorial discusses overdiagnosis in breast cancer.
National Quality Partners. Washington, DC: National Quality Forum; 2016.
Antimicrobial stewardship has been promoted as a strategy to improve patient safety by reducing overuse of antibiotics to prevent hospital-acquired infections. This report draws from the experience of existing programs to summarize practical strategies for implementing initiatives. Core elements include engaging leadership, monitoring effectiveness, and reporting benchmarks.
Larson CK, Kao H. JAMA Intern Med. 2015;175:1750-1751.
Overprescribing can increase risk of dementia, particularly among older patients. This commentary describes an incident involving a patient with moderate dementia that worsened when opioids were prescribed following a fall. After a geriatrician evaluated the patient and suspected polypharmacy, the drugs were stopped, caregivers were educated about how to treat the patient, and the patient improved. Highlighting the importance of environmental interventions in treating this patient, the author reviews strategies to address neuropsychiatric symptoms of dementia.
Filice GA, Drekonja DM, Thurn JR, et al. Infect Control Hosp Epidemiol. 2015;36:949-56.
Overuse of antibiotics is a major factor in the development of certain types of health care–associated infections. This retrospective study found that unnecessary antibiotic use was often a result of diagnostic error, particularly in patients who were empirically treated for urinary tract infections without clear diagnostic evidence. The results of this study imply that addressing diagnostic uncertainty should be a component of antimicrobial stewardship programs.
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