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Top 10 patient safety threats of 2024: Helping new clinicians, maternal care barriers, AI, and more


ECRI outlines key challenges in protecting patients. Dr. Marcus Schabacker, CEO of the patient safety group, talks with us about the dangers to patients.

When ECRI unveiled its list of the leading threats to patient safety for 2024, some items are likely to be expected, such as physician burnout, delays in care due to drug shortages or falls in the hospital.

However, ECRI, a nonprofit group focused on patient safety, placed one item atop all others: the challenges in helping new clinicians move from training to caring for patients.

In an interview with Chief Healthcare Executive®, Dr. Marcus Schabacker, president and CEO of ECRI, explained that workforce shortages are making it more difficult for newer doctors and nurses to make the transition and grow comfortably.

“We think that that is a challenging situation, even the best of times,” Schabacker says. “But in this time, these clinicians who are coming to practice now had a very difficult time during the pandemic, which was only a couple years ago, to get the necessary hands-on training. And so we're concerned about that.”

ECRI released its report on the top 10 threats to patient safety last week.

To be clear, Schabacker stresses that he’s not faulting the newer clinicians who are striving to do their best.

“We have not done enough to prepare these clinicians adequately to deal with patients,” he says. “Because it's not their fault. It's our fault. It's not their fault. They're eager to learn, they're eager to get started. But we can provide them or we have to do extra steps to provide them the necessary training, the transition to practice, and give them better support in making that difficult transition, which is difficult for anybody.” (See part of our conversation with Marcus Schabacker in this video. The story continues below.)

Some experienced clinicians have left the industry, and newer clinicians are often forced to learn the ropes with less guidance from seasoned peers.

“We see a record number of experienced clinicians, both nurses, as well as physicians, as technicians leave the field because they're burned out,” Schabacker says. “Staffing shortages … continue to be a big issue.”

Bedside nurses on 12-hour shifts have less experience, and some can be overwhelmed and discouraged with fewer veterans to help them along the way. Nursing leaders have said the lack of mentoring has driven some newer nurses out of the profession.

“It creates this vicious circle,” Schabacker says. “And so because now we have the lack of the senior nurses who can supervise and guide and coach, the younger nurses are thrown into the deep end and have to take on tasks which they're really not equipped to. They have maybe the theoretical knowledge, but they don't have the practical experience. So that stresses them out. And that leads to more burnout. And so then they might just get discouraged and leave early because they say, ‘This is not what I signed up for.’”

Workarounds with barcodes

The second leading threat on the list involves problems with clinicians employing workarounds with barcode medication administration systems.

The barcode systems are designed to reduce the risk of medical errors, but if there are scanning and labeling errors, staff can develop workarounds which could threaten patients, ECRI notes in the report.

Those workarounds also suggest some staff don’t recognize the safety value of the technology.

“The most shocking, for us, was that people often didn't realize that these workarounds really create problems for them further down the road,” Schabacker said.

“And so that's why we want to call it out and say, ‘Hey, it's not okay.’ It's there for a reason. It's like you're supposed to wear a seatbelt. And if you don't wear the seatbelt, there's dire consequences … The barcode scanning is our seatbelt for medication errors,” he says.

Maternal health barriers

ECRI cited barriers to maternal and perinatal care as the third leading threat to patient safety. About 1 in 3 counties nationwide are classified as maternity care deserts due to a lack of obstetric services.

“​​Where there's no services whatsoever available for those folks, as you can imagine, that clearly leads to a higher risk for those mothers and their unborn children,” Schabacker says. “And it's getting worse because more gynecologists and obstetricians are leaving the field.”

Rural communities are especially vulnerable due to the dearth of maternity services, with some patients needing to drive significant distances to see doctors.

“It's really the heartland where there's no or insufficient services,” Schabacker said. “And that causes a major risk.”

Maternal deaths rose 40% in 2021 compared to the previous year, according to figures from the National Center for Health Statistics. Compared to 2018, the maternal mortality rate has risen 89%, according to federal data.

AI and other technology

The adoption of new technology can have unintended consequences on patients, and that ranked fourth on ECRI’s list.

That includes the growing use of AI in healthcare.

AI is being used successfully in areas such as medical imaging, the report notes. But ECRI also points out that AI’s quality relies on the accuracy of data, and faulty AI tools could lead to misdiagnosis and inappropriate decisions on care.

In addition, AI tools could rely on data and research that doesn’t include a diverse set of patients.

“The problem is, we don't understand, we don't often know how those algorithms were generated, what populations that algorithm was trained on,” Schabacker says.

Declining well-being of clinicians

Doctors and nurses continue to struggle with their well-being, both emotionally and physically. The declining well-being of clinicians ranked fifth on ECRI’s list of threats to patient safety.

The high levels of burnout among physicians and nurses continue to be a major problem, Schabacker said. In addition, doctors and nurses in hospitals are encountering violent or aggressive situations with alarming regularity.

“Staffing shortages lead to longer wait times, lead to less service, lead to more stressed nurses and clinicians,” Schabacker says. “So the services get worse, you don't get the attention, you don't get the amount of time you think you deserve, and so it escalates very quickly.”

Health systems should look at the top two or three issues with the well-being of their workforce, and tackle those challenges. With progress in even a couple of areas, staff well-being and patient safety are likely to improve, Schabacker says.

The full list

Here is the full list of patient safety concerns identified by ECRI.

ECRI’s top 10 threats to patient safety for 2024

1. Transitioning new clinicians from education into practice

2. Workarounds with barcode medication administration systems

3. Barriers to access to maternal care

4. Unintended consequences of technology adoption, including AI

5. Decline in physical and emotional well-being of healthcare workers

6. Complexity of preventing diagnostic error

7. Ensuring equitable care for patients with physical and intellectual disabilities

8. Care delays due to drug, supply, and equipment shortages

9. Misuse of parenteral syringes to administer oral liquid medications

10. Continued challenges with preventing patient falls

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