By John Commins
“Medical errors are the third leading cause of death in the country,” says Marcus Schabacker, MD, president and CEO, ECRI Institute. “This guidance can help healthcare leaders and clinicians save lives.”
Healthcare providers rely on EHRs to help with clinical decision support and tracking test results. But that technology is just one tool in the diagnostic process, said William Marella, executive director of operations and analytics, at ECRI Institute PSO.
“We have to recognize the limits of current technology and ensure that we have processes in place to close the loop on diagnostic tests,” Marella said. “This safety issue cuts across acute and ambulatory settings, requiring teamwork across the health system.”
ECRI Institute’s 2019 list of concerns addresses systemic issues facing health systems, such as behavioral health concerns, clinician burnout, and skills development. Mobile health technology, number four on the list, opens up a world of opportunities by transporting healthcare to the home, but also presents potential risks.
The report also highlights ongoing clinical issues with infections from peripheral IV lines, sepsis, and anti-microbial stewardship. In the outpatient setting, at least 30% of antibiotic use is unnecessary.
The 2019 Top 10 Patient Safety Concerns are:
- Diagnostic Stewardship and Test Result Management Using EHRs. “Providers have begun relying on the electronic health record (EHR) to help with clinical decision support, to track test results, and to flag issues. However, the EHR is only part of the solution.”
- Antimicrobial Stewardship in Physician Practices and Aging Services. “Perhaps the most significant challenge facing antibiotic stewardship is managing patient expectations. Moreover, unnecessary antibiotic administration puts patients at unnecessary risk of adverse drug reaction. And the broadest concern is that overprescribing leads to antimicrobial resistance.”
- Burnout and Its Impact on Patient Safety. ” The electronic health record is a contributing factor, but burnout goes beyond providers’ oft-described frustrations with documentation. Healthcare is evolving rapidly and keeping up with the changes can be a challenge.”
- Patient Safety Concerns Involving Mobile Health. “Risks of mobile health technology include lack of regulation of new technologies, barriers to ensuring that providers are accurately receiving the data a device collects, and the possibility that a patient is not using the technology correctly or is not using it at all.”
- Reducing Discomfort with Behavioral Health. ” In many healthcare settings, behavioral and physical health are siloed. But people with behavioral health needs are in every setting, and it is not always obvious when an individual has such needs.”
- Detecting Changes in a Patient’s Condition. ” Sometimes staff are inadequately trained in recognizing changes in a patient’s condition or in responding to an alarm that is alerting caregivers to check on a patient.
- Developing and Maintaining Skills. “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.”
- Early Recognition of Sepsis across the Continuum. “To facilitate timely diagnosis and management, healthcare organizations across the continuum should have protocols for response when sepsis is suspected, much as they do for chest pain.”
- Infections from Peripherally Inserted IV Lines. “Increased awareness of PIV-catheter-related infections, coupled with routine active surveillance and follow-up reporting, can help reduce the risk.”
- Standardizing Safety Efforts across Large Health Systems. “Regardless of organization size, the goal is to institute structures that effectively allow patient safety leaders to support organization leadership in engaging with patient safety priorities.”
ECRI’s list does not necessarily represent the most frequently or most severe safety issues.
It identifies new risks, how existing concerns may be changing because of new technology or care delivery models, and persistent issues that need renewed attention or that might have additional solutions.