Multisite review shows serious adverse events occur frequently in outpatient care

Embargoed for release until 5:00 p.m. ET on Monday 6 May 2024    
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.    
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1. Multisite review shows serious adverse events occur frequently in outpatient care

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2063  

Editorial: https://www.acpjournals.org/doi/10.7326/M24-0876  

URL goes live when the embargo lifts     

A multisite review of electronic health records (EHRs) found that adverse events during outpatient care were relatively common and often serious. Adverse drug events accounted for about two-thirds of adverse events. Other events included health care–associated infections and surgical or procedural events. The review is published in Annals of Internal Medicine.

Researchers from Brigham and Women’s Hospital and Harvard Medical School conducted a retrospective review of EHRs for 3,103 patients receiving outpatient care. They found that 7 percent of outpatients experienced at least one adverse event, with drug events being the most common. Adverse events occurred more frequently among older adults and were often preventable. According to the authors, these data serve as an urgent call for patient safety research and innovation in the outpatient setting. They suggest systems that track and intervene on outpatient adverse events to become routine and standardized.

An accompanying editorial from the University of California San Francisco highlights the ways in which outpatient care has transformed since the study was conducted and may provide opportunities for intervention. The author notes that the use of patient portals to engage with outpatient care has significantly increased since 2018, expanding contact between patient and clinician in between visits. The author also points to the more regular use of generative artificial intelligence in health care settings as a tool to transform the study of outpatient safety. Finally, the author emphasizes the importance of patient and family engagement in outpatient care safety interventions.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, David M. Levine, MD, MPH, MA, please contact Serena Bronda at sbronda@bwh.harvard.edu.

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2. Medical ethicists offer a moral argument for abortion in the case of medical emergencies

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0276    

URL goes live when the embargo lifts     

Medical ethicists from Oakland University William Beaumont School of Medicine offer a moral argument to support the provision of abortion in the case of pregnancy emergencies, using the Emergency Medical Treatment and Labor Act (EMTALA) as a rationale. The commentary is published in Annals of Internal Medicine.

The authors suggest that any argument over public policy should use public reason, identifying key premises that are contestable using public reason, and assert the precautionary principle. For example, some states, including Texas, have challenged the legal authority of EMTALA to require abortions in pregnancy emergencies and this challenge was supported by the Fifth Circuit Court of Appeals. Rejecting the pregnancy emergency inclusion in EMTALA is flawed, the authors say, because it is unclear at what precise point the risk to the health of the pregnant patient outweighs the death to the fetus. This threshold, like many in medicine, many be difficult to define but is still important to balance in the treatment of patients. The basic argumentative method may be applicable when assessing other challenges to the requirement and may also be apt when advocating for abortion exceptions beyond life and health, such as in the case of rape, incest, or fatal fetal anomalies.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Abram Brummett, PhD, please contact abrummett@oakland.edu.

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3. Ultrasound may be viable first-line diagnostic tool for persons with suspected GCA

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3417    

URL goes live when the embargo lifts      

A cohort study of persons with suspected giant cell arteritis (GCA) found that the use of ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided. The study is published in Annals of Internal Medicine.

Researchers from the Centre Hospitalier Rochefort, Rochefort, France, conducted a prospective cohort study of 165 patients with high clinical suspicion of GCA. The authors examined the use of color Doppler ultrasound of the temporal artery as a first-line diagnostic test and temporal artery biopsy (TAB) as a secondary test. The authors found that a diagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. According to the authors, their findings show that the use of temporal artery ultrasound may be an efficient way to make the diagnosis of GCA in patients with high clinical suspicion and to reduce imaging costs and the need for biopsy, thereby limiting complications and the need for a surgeon.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Guillaume Denis, MD, please contact guillaume.denis@ght-atlantique17.fr.

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