2019 Top 10 List of Patient Safety Concerns

Ken Terry

March 13, 2019

The ECRI Institute named diagnostic errors and improper management of test results in electronic health records (EHRs) as the top patient safety challenge facing healthcare organizations in its just-released report, "2019 Top 10 Patient Safety Concerns."

This was the second year in a row that diagnostic errors were flagged as the most serious safety challenge in ECRI's annual compendium. Many healthcare providers rely on EHRs for clinical decision support and test result tracking, ECRI notes, and providers should remember that these systems are only one element in the diagnostic process.

"We have to recognize the limits of current technology and ensure that we have processes in place to close the loop on diagnostic tests," said William Marella, executive director of operations and analytics for ECRI's patient safety organization (PSO), in a news release. "This safety issue cuts across acute and ambulatory settings, requiring teamwork across the health system."

The diagnosis, treatment plan, and follow-up plan must be clearly communicated in the EHR and must be written in a way that other clinicians can understand, the report states.

The second most important issue on ECRI's 2019 list is antimicrobial stewardship in physician practices and aging services. In the outpatient setting, the institute noted in its press release, at least 30% of antibiotic use is unnecessary and contributes to antimicrobial resistance.

To reduce this threat, the report says, physicians must manage patient expectations. Patients often expect antibiotics to help them get better. But in some cases, the best policy is to "give them a prescription for what to do, what to watch for. Follow up with them," ECRI recommends.

Burnout's Role in Safety

Burnout and its impact on patient safety is the number 3 issue on the ECRI list. "Studies show that burnout has a consistent negative relationship with safety and quality," the report's authors point out.

Although burnout can be related to the challenges of using EHRs, ECRI says, its causes go far beyond that. "Healthcare is evolving rapidly and keeping up with the changes can be a challenge. Time pressures are intense. Providers are caring for an increasing number of patients with complex medical conditions, drawing on limited resources."

Individual clinicians cannot prevent burnout by themselves, the report states. Healthcare organizations must also address this problem. They must "listen to providers' concerns about workload, performance criteria, and suboptimal resource allocation and fix these problems at a system level."

Patient safety concerns involving mobile health snags the number 4 slot. ECRI is highlighting remote monitoring devices that communicate with providers through smartphones or computers. The main patient safety risks are inadequate government regulation, barriers to ensuring that providers accurately receive data, and the possibility that a patient is not using the technology correctly or at all.

Many mobile devices, says the report, are released without testing by the US Food and Drug Administration. Therefore, healthcare organizations must ensure the safety and validity of any device they recommend to a patient. Organizations must also identify the right candidates for mobile healthcare and provide training to both providers and patients.

Number 5 on the ECRI list is reducing discomfort with behavioral health. Patients with behavioral health needs are present in every care setting, the report states, but healthcare providers don't necessarily recognize this or treat these patients appropriately.

To remedy this situation, the report recommends certified training, training led by internal experts or consultants, community behavioral health first-aid workshops, or a combination. Also, healthcare organizations should utilize community resources whenever possible.

Recognizing Changes in Patients

Detecting changes in a patient's condition and recognizing sepsis early on are the sixth and eighth biggest challenges, respectively, on ECRI's list. Health status changes are often missed during transitions of care, underlining the importance of good communications between providers during those handoffs. In hospitals, staff members need training in how to operate monitoring equipment and respond appropriately to alarms, ECRI points out.

As healthcare delivery shifts from inpatient to outpatient care, the report says, it is critically important to recognize sepsis in ambulatory care and aging services settings.

"Healthcare workers throughout the continuum of care must be able to recognize sepsis. Certified nursing assistants can be trained to use screening tools, and physician practices can screen for sepsis both in the exam room and on the phone. Simulation and skills practice can help workers recognize sepsis and communicate their concerns."

Simulation Training

Number 7 on the patient safety list is developing and maintaining skills. The report notes, "Patient harm can occur if staff are uncomfortable using medical equipment or performing a procedure, or are unaccustomed to an organization or care area's processes."

To address this challenge, ECRI makes a strong pitch for simulation training, which has been shown to improve outcomes. Simulation training gives healthcare professionals opportunities to practice their skills and can be implemented at low cost, the report states.

The ninth biggest safety challenge is infections from peripherally inserted IV lines. PIV catheters, according to the report, may be routinely inserted at the time a patient is admitted in case they're needed later. But it's a mistake to insert these lines without a good reason, because they expose patients to the risk for infection, ECRI says.

At the bottom of the top 10 list is standardizing safety efforts across large health systems. With the consolidation of some healthcare system into "nationwide mega-systems," the report states, there is a concern that some of these giant organizations might not prioritize patient safety.

ECRI recommends that these mega-systems establish structures that allow patient safety leaders to support organization leadership in engaging with patient safety priorities. In addition, it suggests that very large organizations create patient safety organizations to leverage the protections that these organizations afford to clinicians in reporting safety incidents. Under the Patient Safety and Quality Improvement Act of 2005, which laid the groundwork for PSOs, these protections extend across state lines, ECRI notes.

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