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ECRI, a nonprofit group focused on improving safety in healthcare, has released its annual analysis. The group’s president offers suggestions for hospital leaders to protect patients.
Healthcare staffing shortages and the stress on clinicians from the COVID-19 pandemic have emerged as the leading threats to patient safety, according to a new report.
ECRI, a nonprofit group focused on improving safety in healthcare, released its latest annual report Monday on the top 10 threats to patient safety. In past years, ECRI’s list cited medical errors or problems with devices as the top concerns for patients.
This year’s list is different, due to the impact of the COVID-19 pandemic on healthcare systems.
Staffing shortages of doctors and nurses have been a persistent healthcare problem for years, but the problem has worsened since the arrival of the coronavirus in 2020, said Marcus Schabacker, president and CEO of ECRI.
“What we’ve seen in the pandemic is it’s accelerated and it’s taken on new levels,” Schabacker said in an interview with Chief Healthcare Executive.
“There is some clinical evidence that for each additional patient a nurse needs to take on, there’s an increased risk of mortality of 7%,” he said. “If you were a patient, you’d be worried about that.”
If the healthcare industry doesn’t develop a broader physician workforce, patients could be facing greater risks in the years to come. “If you think it’s bad with waiting times right now for a specific specialty, it’s only going to get aggravated over time,” Schabacker said.
Staffing shortages and stress on healthcare workers have received growing attention in recent months. But ECRI said its analysis indicates both issues are having an impact on patient safety.
Due to staffing shortages, hospitals have less capacity to treat patients and patients are waiting longer for care and, in some cases, they’re being turned away, ECRI found.
In recent months, healthcare organizations have bemoaned shortages of doctors, nurses and others involved in patient care. Roughly 1 in 5 healthcare workers have left the industry since the beginning of the pandemic, according to a report by Morning Consult.
That would be bad enough, but ECRI noted the growing concern that more doctors and nurses may be calling it quits soon. A recent report found 1 in 5 doctors, and 40% of nurses, said they will walk away in the next two years due to the stress they’ve experienced.
It's going to take years to fully address the shortage of doctors and nurses, but Schabacker said it must be a concerted efforts involving the federal government, healthcare organizations and academic institutions.
The ECRI report included data on the mental stress on healthcare workers, with 20% of doctors saying they’ve experienced burnout and 29% of physicians saying they’ve been treated for anxiety or depression. Most nurses have said their mental health is suffering, but only 10% are seeking counseling services, a recent survey found.
Burnout and fatigue can threaten patient safety, and Schabacker pointed to a rise in medication errors. “If you are fatigued, if you are frustrated, you are automatically going to be less of a top performer,” he said.
Healthcare leaders have also said they are increasingly concerned about burnout and the mental health of their workers. Those concerns have led to the passage of federal legislation to provide more funds and education to address mental health in the healthcare workforce.
Many healthcare workers often don’t seek mental health treatment because they are worried as being seen as weak or don’t want to let their colleagues down. Some doctors and nurses are reluctant to seek help because they fear it could hurt their careers.
Healthcare leaders have to make mental health a priority and make sure their staff are getting the help they need, Schabacker said.
“It is a problem and you’ve got to address it proactively,” he said. “You’ve got to force your healthcare workers to acknowledge it, and force them to take action, because a lot of them won’t.”
Bias and racism
The ECRI report cited bias and racism as another chief concern for patient safety. It ranked third on this year’s report.
Black patients are more likely to suffer patient safety events than white patients, according to the report. It’s particularly alarming that disparities of care can be seen between Black patients and white patients with the same diagnosis in the same facility, even if they have comparable insurance coverage, Schabacker said.
“That’s concerning. It signals that there’s either implicit or unconscious biases,” he said.
Even though minority patients are more likely to suffer adverse events in hospitals, providers are less likely to report those harmful events, the ECRI report stated.
Healthcare organizations need to examine patient outcomes and ask hard questions if they’re finding disparities in outcomes with minority patients, Schabacker said.
“Leaders need to do frequent analysis of safety events by ethnicity,” he said. “If you see a difference, do a root cause analysis.”
“You’ve got to measure it, you’ve got to analyze it,’ he added. “It takes an active effort. It won’t happen by itself.’
Studies are demonstrating links between structural racism and healthcare. A recent study also found electronic health records showed evidence of bias and discrimination involving Black patients, raising more potential for inequity in care.
The ECRI report lists some well-known areas of concern for patient safety, but Schabacker cited one area that he said doesn’t get enough attention: pneumonia in healthcare systems that isn’t tied to the use of ventilators. It ranked 6th on the list.
Pneumonia is the “number one infectious risk in the hospital,” Schabackers said. He encouraged chief medical officers to look at non-ventilator pneumonia cases to see why they are happening and if they are tied to certain treatments.
The human factors in operating telehealth can lead to errors affecting patients (this came in 7th on the list). Patients without high-speed internet can’t take advantage of some video services, and not everyone has high-quality cameras which are needed for a proper diagnosis, Schabacker said. A federal study found some patients in minority groups are less likely to use video telehealth services, which is a concern because early evidence suggests video is more effective in telehealth.
Federal officials have indicated they are increasingly concerned with the safety of patients and healthcare staff.
The U.S. Labor Department announced it would begin focused inspections of hospitals and nursing homes over the next three months. The inspections will focus on how facilities are treating COVID-19 patients and protecting workers.
Federal officials have drawn attention to troubling indicators of declines in patient safety since the pandemic emerged. Some gains in previous years were quickly wiped out by the COVID-19 pandemic, officials said. In an analysis published in the New England Journal of Medicine, leaders with the Centers for Medicare & Medicaid Services and the CDC said there are disturbing indicators, including a sharp rise in infections.
To compile the report, ECRI said it studied patient safety events, concerns reported to ECRI, scientific literature, and a wide array of data sources.
The top 10
Here’s the full rundown of ECRI’s top 10 concerns for patients in 2022.
1. Staffing shortages
2. COVID-19 effects on healthcare workers’ mental health
3. Bias and racism in addressing patient safety
4. Vaccine coverage gaps and errors
5. Cognitive biases and diagnostic error
6. Nonventilator healthcare-associated pneumonia
7. Human factors in operationalizing telehealth
8. International supply chain disruptions
9. Products subject to emergency use authorization
10. Telemetry monitoring