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These are the top 10 threats to patient safety in 2023


ECRI, a nonprofit focused on protecting patients, releases its annual list of the most pressing concerns. Marcus Schabacker, CEO of ECRI, talked with us about the leading issues.

Hospitals and clinicians have been warning about the mental health crisis in children, and it’s now being named the most serious threat to patient safety.

ECRI, a nonprofit group focused on patient safety, has called the pediatric mental health crisis the top patient safety concern for 2023 in a new report released this week.

Among other concerns, Ecri identified violence against healthcare workers as the second most pressing issue, followed by the uncertainty for doctors in the wake of last year’s Supreme Court ruling that abortion is no longer a constitutional right.

In an interview with Chief Healthcare Executive®, Marcus Schabacker, president and CEO of ECRI, said the goal of the report is to spotlight patient safety concerns that need more attention. With that in mind, Ecri chose to put the pediatric mental health crisis atop the list.

“When we looked at the data we are seeing in our database and externally, the one thing which really struck us was the tremendous increase in mental health issues concerning kids,” Schabacker said.

Hospitals say they have been treating far more children for mental health emergencies during the COVID-19 pandemic. The American Academy of Pediatrics, the Children’s Hospital Association and more than 100 other groups signed a letter in October urging President Biden to declare a national emergency due the youth mental health crisis.

Health systems are facing a shortage of staff, and Schabacker said it’s having a profound effect on the mental health crisis in kids. He also pointed to the elevated risk of suicide ideation among teens in the LGBTQ+ community.

By naming it as the single greatest concern of patient safety, Schabacker said Ecri is making “a very deliberate” effort to draw more attention to the mental health of young people.

“We need to call this out because as you know, Ecri is always trying to focus on things which might not get the attention, and where we can do things about it, if we work together,” he said. “And it will take a village. This is not something one particular person or institution or agency can fix.”

He also warned of the long-term consequences, to young people and all of society, by failing to get kids the help they need.

“We’ve got to catch it early,” he said. “It's like any other disease, when you catch it early, you have a chance to mitigate the late stage, late onset consequences.”

(See part of our discussion on patient safety with Marcus Schabacker in this video. The story continues below.)


Many physicians and nurses say they have seen an increase in violence during the COVID-19 pandemic, and that’s threatening patient care, Schabacker said. And that’s why ECRI chose healthcare violence as the second leading threat to patient safety this year.

“Think about it,” he says. “If you are feeling unsafe, insecure, if you feel that you have to protect yourself, you don't know if somebody is going to attack you, how are you going to show up at work? What is it doing to your state of mind?”

Over half of emergency doctors say they have been physically assaulted, according to a recent poll of the American College of Emergency Physicians. Some healthcare leaders point to the uptick in attacks as another impediment to retaining key staff.

While doctors, nurses and other healthcare workers are striving to do their best, it isn’t easy to brush off a heated or violent encounter.

“If I'm in a hospital,” Schabacker said, “and I've just been the victim of verbal or even physical abuse, can I then just switch that off and concentrate on my next patient?”

Hospital leaders must focus on protecting their staff and reducing violence. He said that involves everything from security provisions to reducing wait times in the emergency department, which can trigger violent episodes, he said.

“It takes the leadership to create a culture and saying where we commit to our workforce that we won't tolerate this and we create an environment where this becomes less likely,” Schabacker said.

He also talked about the importance of training staff on de-escalation strategies and stressing to patients that violence won’t be tolerated.

Fallout of abortion ruling

Health systems and physicians are grappling with the fallout of the Supreme Court’s decision last June on the issue of abortion. With the high court ruling abortion is not a constitutional right, the issue has been left to the states, and some states have barred virtually all abortions, with limited exceptions.

Schabacker stressed ECRI isn’t weighing in on the politics of abortion. But he said doctors are facing difficult decisions and they need better guidance on when they can intervene. With those issues in mind, ECRI named maternal-fetal care as the third leading concern for patient safety.

“It is the insecurity about what is legally allowed,” Schabacker said.

Healthcare organizations, doctors and pharmacists have said state laws are too vague regarding emergency care in the wake of the Supreme Court ruling on abortion last year. Legal battles are ongoing at the state level over the rights of doctors to perform an abortion to save the life of the mother.

“I think we left the healthcare providers, the clinicians, on a limb because they are faced with life and death situations,” Schabacker said. “It is not feasible to expect that they know the law in detail so they can decide, ‘What am I legally allowed to do?’

Schabacker said hospital leaders must analyze what clinicians are “allowed to do and not allowed to do under the law in your specific state, and then educate your staff and help them to develop strategies, clinical pathways on how to deal with that.”

Because of the lack of clarity in the laws in some states, Schabacker said, “It will delay treatment and it will cause patient harm. That's what we're concerned about.”

Care coordination

Schabacker noted other concerns on the list, including delayed treatment of sepsis, which can lead to a much higher mortality rate if not addressed promptly. He also noted enduring concerns of health equity leading to those from underserved communities having less access to care.

He pointed to one other area as needing more attention, and that involved poor care coordination for patients with complex medical conditions. It landed sixth on the list.

While patients are living longer with conditions such as diabetes or hypertension, they are also going to need ongoing care, and the onus can be on patients to explain to different caregivers their medications and preconditions.

“It becomes more and more important to coordinate the care between the individual caregivers,” Schabacker said. “And with the specialization in the United States, that is not happening.”

“This is only going to get worse, because we're seeing a continuous specialization and we're going to continue to see an aging population,” he added. “We're going to see a continued complexity of diseases and the treatments interfere with each other. And we just have to be much more aware of it.”

The top 10

Here’s the full list of Ecri’s 10 most pressing patient safety concerns for 2023.

1. The pediatric mental health crisis

2. Violence against healthcare staff, physical and verbal

3. Uncertainty for doctors after the Supreme Court ruling on abortion

4. Impact on clinicians expected to work outside their scope of practice

5. Delayed identification and treatment of sepsis

6. Consequences of poor care coordination for patients with complex medical conditions

7. Risks of not looking beyond the “five rights” to achieve medication safety

8. Medication errors resulting from inaccurate patient medication lists

9. Accidental administration of neuromuscular blocking agents

10. Preventable harm due to omitted care or treatment

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