Study objective We examine the characteristics of clinical decision support alerts triggered when opioids are prescribed, including alert type, override rates, adverse drug events associated with opioids, and preventable adverse drug events. Methods This was a retrospective chart review study assessing adverse drug event occurrences for emergency department (ED) visits in a large urban academic medical center using a commercial electronic health record system with clinical decision support. Participants include those aged 18 to 89 years who arrived to the ED every fifth day between September 2012 and January 2013. The main outcome was characteristics of opioid drug alerts, including alert type, override rates, opioid-related adverse drug events, and adverse drug event preventability by clinical decision support. Results Opioid drug alerts were more likely to be overridden than nonopioid alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50). Opioid drug-allergy alerts were twice as likely to be overridden (relative risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57 times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581 patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%), and 8 were due to opioids (57.1%). None of the adverse drug events were preventable by clinical decision support. However, 46 alerts were accepted for 38 patients that averted a potential adverse drug event. Overall, 98.9% of opioid alerts did not result in an actual or averted adverse drug event, and 96.3% of opioid alerts were overridden. Conclusion Overridden opioid alerts did not result in adverse drug events. Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts. To prevent 1 adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety.

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Identifies factors that practitioners consider most important in suicide risk assessment Discusses how to distinguish between chronic and acute risk for suicide Identifies factors that lead to more consistent clinical judgments.

Background Driving self-restriction is a well-documented among older drivers but might also occur among younger drivers. Little is known about the driving patterns of emergency department (ED) patients, who may be a high-risk population for motor vehicle crashes (MVCs). We sought to compare the driving patterns and MVCs of younger and older adult ED patients in order to inform development of injury prevention interventions in EDs. Methods We surveyed English-speaking younger adult (age 25-64) and older adult (age ≥65) ED patients, excluding non-drivers and those who were cognitively-impaired or too sick to participate. We compared drivers by age group and used logistic regression with adjustment for driving frequency to examine factors associated with driving self-restriction. Results Of those eligible, 82% (n=178) of younger adult and 91% (n=134) of older adult patients participated; approximately half were women. Similar proportions of younger and older adult patients reported driving everyday/almost everyday (80%) but also self-restricting driving in inclimate weather (48%), heavy traffic (27%), in unfamiliar places (21%), when travelling with passengers (1.6%) or when alone (1.3%). Fewer younger adult than older adult patients avoided driving at night (22% versus 49%) or on highways (6.7% versus 26%). In multivariable logistic regression, factors significantly associated self-imposed driving restriction in ≥1 driving situation were female gender (Odds Ratio [OR] 2.40; 95%CI 1.42-4.05) and ever feeling “confused, nervous or uncomfortable” while driving (OR 1.87; 95% CI 1.03-3.39). There was a non-significant trend for differences in proportions between younger adult (11%) and older adult (6.8%) drivers reporting ≥1 MVC as a driver in the past 12 months. Conclusions Similar proportions of younger and older adult ED patients self-restrict driving, albeit in different situations, which has implications for behavioral interventions for injury prevention and for education of patients and medical providers.