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Perspectives on Safety > Perspective
with commentary by Nancy C. Elder, MD, MSPH, Outpatient Safety, May 2006
Dr. Jones was sure he had increased Mr. H's cholesterol-lowering medication to 80 mg 6 months ago, but, at his visit today, his pill bottle still says 40 mg. In reviewing Ms. B's chart in preparation for performing a well-woman examination, Dr. Smith find...
Perspectives on Safety > Interview
The Comprehensive Care Physician Model, November 2018
Dr. Meltzer is the Fanny L. Pritzker Professor of Medicine, Chief of the Section of Hospital Medicine, and Director of the Center for Health and the Social Sciences at the University of Chicago. His research aims to improve the quality and lower the cost of hospital care. We spoke with him about the Comprehensive Care Physician Model, which he pioneered and was recently featured in an article in The New York Times Magazine.
Journal Article > Study
Residents' perceptions of professionalism in training and practice: barriers, promoters, and duty hour requirements.
Ratanawongsa N, Bolen S, Howell EE, Kern DE, Sisson SD, Larriviere D. J Gen Intern Med. 2006;21:758-763.
The researchers surveyed residents on the impact of duty hour restrictions on professionalism. They found that residents thought it more difficult to incorporate professionalism with the restrictions in place but also thought well-being and teamwork were improved.
Journal Article > Commentary
Elder NC. BMJ Qual Saf. 2015;24:667-670.
Insufficient communication of laboratory test results can contribute to delays in diagnosis. Discussing poor communication regarding test results in primary care, this commentary advocates for research to understand the best ways to notify patients about their results and involve patients in shared decision-making so that they understand the physician's interpretation and recommendations.
Tools/Toolkit > Government Resource
Itasca, IL: American Academy of Pediatrics; 2018.
Diagnostic error prevention in primary care is a persistent challenge. This AHRQ-funded toolkit provides guidance for ambulatory care organizations that seek to improve the reliability of diagnosis in children. The material focuses on tactics to enhance how practices recognize, track, and follow up on adolescent depression, pediatric elevated blood pressure, and actionable laboratory results.
Journal Article > Study
Neprash HT, Barnett ML. JAMA Netw Open. 2019;2:e1910373.
The root causes of the opioid epidemic are complex, but inappropriate prescribing of opioids (which includes both prescribing opioids in situations where they are not indicated as well as excessive prescribing for appropriate indications) is a major contributor. Prior studies of outpatient antibiotic prescribing have shown that rates of inappropriate prescribing rise toward the end of clinicians' clinic sessions. This cross-sectional study used data from 5603 primary care physicians for acute painful conditions to analyze whether a similar relationship exists for opioid prescribing. Investigators found that the likelihood of opioid prescribing rose considerably as the workday progressed; clinicians were also more likely to prescribe opioids if their appointments were running late. In contrast, prescriptions for nonopioid therapies did not change in relation to appointment time. Although the magnitude of these effects was smaller than the variation in opioid prescribing rates between physicians found in other studies, these findings confirm that production pressure and decision fatigue contribute to inappropriate prescribing and should be addressed in quality improvement efforts to reduce opioid use.