March 27, 2019

Incomplete use of electronic health records (EHRs) in making diagnoses and managing test results led the list of the ECRI Institute’s Top 10 Patient Safety Concerns for 2019.

Technology is just a tool, and an over-reliance on electronic clinical decision support and other features to identify all of the key elements to deliver the correct diagnosis creates an environment with potential to cause harm, the report stressed.  “To help ‘close the loop,’ providers must not only fully utilize an EHR designed to meet their practices’ unique needs, but also recognize the importance of clear communication, both among caregivers and between caregivers and patients,” the report said.

The ECRI Institute is an independent, non-profit healthcare research organization that provides information to support the delivery of safe, cost-effective care.

The list was drawn from 2.8 million event reports in ECRI’s database, as well as from a review of events, root-cause analyses by participants in the non-profit organization’s patient safety collective, and voting by a panel of internal and external safety experts.  The breadth of data and other information sources used to develop the list means that the safety concerns “are very real,” according to the report’s executive brief.  “They are harming people, sometimes seriously.”

The report notes that the list does not necessarily represent the most frequent or most severe patient safety issues, because healthcare providers already know what those issues are at their own institutions.  Rather, the list brings attention to concerns that ECRI contends are high priorities for other reasons, including emerging risks, changes in existing risks due to new technology or care delivery models, or persistent issues that call for a fresh approach.

Also leading the list of 2019 patient safety concerns were:

Antimicrobial stewardship in physician practices and aging services.  “We have casually and cavalierly handed around a candy dish of antibiotics without a second thought as to how we may be harming our patients,” the report stressed.  With resistance to antibiotics on the rise due to longstanding patterns of antibiotic overprescribing, providers must implement antimicrobial stewardship programs that focus on whether an antibiotic is appropriate for the patient being treated.

“Patients need to feel like they are being taken care of, even without a prescription for an antibiotic,” the report stated.  “Antibiotic stewardship does not mean withholding unnecessary treatment,” but unnecessary prescriptions increase patients’ risk of adverse drug reactions and resistance.

Burnout and its impact on patient safety.  Research has shown that burnout can negatively affect patient safety and the quality of care.  According to the report, while the time clinicians are required to spend on electronic documentation is a driving factor in burnout prevalence, the problem is a much larger issue that also encompasses the pace of change in medical science and the pressure of caring for a growing number of complex patients with limited resources.

To address the issue, “organizations must listen to providers’ concerns about workload, performance criteria, and suboptimal resource allocation and fix these problems at a system level,” the report recommends.

Patient safety concerns about mobile health.  Although mobile technology opens new doors to enhance the efficiency and quality of medical care, lack of regulation of new technologies, concerns about the potential that providers may not receive accurate data from devices, and the possibility that patients won’t use the technology correctly or at all present barriers that must be addressed.

“Healthcare organizations must ensure the safety and validity of any device they recommend to a patient and be certain the device will work when the patient leaves the healthcare facility,” the report said.  “Most important is matching patient health conditions to the right piece of technology as well as assessing the likelihood the patient will accept mobile technology.”

Other patient safety issues on the list were:

Reducing discomfort with behavioral health, including breaking down silos between physical and behavioral health.  “People with behavioral health needs are in every setting,” according to the report.

Detecting changes in a patient’s condition.  Because transitions of care are particularly fraught with danger, “passing along and receiving the correct information sets providers up for success.”

Developing and maintaining skills.  The safety risks caused by lack of familiarity with equipment and devices can be remedied with simulation training, which allows healthcare professionals to hone their skills.

Early recognition of sepsis across the continuum.  Healthcare professionals in all settings must be able to recognize sepsis and organizations across the continuum must develop protocols to support timely diagnosis and management.

Infections from peripherally inserted IV lines. Increased awareness of PIV-catheter-related infections and routine surveillance and follow-up reporting are needed to reduce the risk.  “Staff need to understand that it can happen, and that it can be serious.”

Standardizing safety efforts across large health systems.  The evolution of healthcare “mega-systems” calls for emphasis among organizations on how they internally structure themselves to keep patient safety at the forefront.

ECRI encourages healthcare organizations to use the list as a starting point for patient safety discussions and planning, to determine whether similar issues should be targeted for intervention, and to develop strategies to address concerns.

The complete report is available here.