These are the top safety risks in health care today

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Here’s what we’re talking about this week.

It’s a terrible time to end up in a hospital.

That sentiment has become a common refrain over the past two years as health care facilities became overloaded with COVID-19 cases and clinicians started quitting in droves.

But perhaps it’s not hyperbole. Pandemic-related issues feature prominently on this year’s list of top patient safety concerns, which the independent ECRI releases annually.

Staffing shortages topped the list, followed by the mental health of clinicians. Other safety risks highlighted include the speed of the covid vaccine rollout, which led to medical errors; supply chain disruptions, and the challenges of adopting telemedicine on such a large scale.

ECRI compiles the list in consultation with physicians and reviews of scientific studies. You can see the full list here .

I caught up with Dr. Marcus Schabacker , ECRI’s president and CEO, to discuss some of those findings and what the health care industry can do about them.

Staffing shortages (#1)

The clinician exodus from health care has been well documented, but hospital administrations responded in the wrong way, he said. Rather than addressing the root cause of burnout, they jumped to the “easy solution” of hiring travel nurses, which further decreased morale among full-time employees and resulted in lost knowledge when each new nurse had to learn the hospital’s systems.

“We would appeal to the administrators,” he said. “If you think everything’s fine, you’re missing an opportunity to proactively address something.”

The pandemic has certainly pushed clinicians to change jobs at a faster clip, but it’s not the only factor driving the staffing shortage. The nursing workforce is aging; 19% of nurses are 65 or older, up from 14.6% in 2017 and 4.4% in 2013, according to the National Nurses Workforce Survey . The patient population is also aging, creating greater demand for health care.

“It’s just a theme that keeps accelerating,” Schabacker said. “And the pandemic has only worsened the situation.”

Vaccine coverage gaps and errors (#4)

The ECRI’s concerns aren’t about the covid vaccines themselves, but missed opportunities to avoid errors. “While the vaccines are very safe, in these times of heightened usage and urgency … mistakes happen and they happen more easily,” Schabacker said.

To scale the rollout, some states expanded the criteria for who was allowed to administer the injections. Pharmacies were also operating short-staffed in many places. Those sorts of factors contributed to mistakes like injectors forgetting to dilute the vaccines.

Other mistakes included mix-ups between adult and children’s shots, or between flu and covid vaccines. Putting the covid vaccines on the list of top safety concerns is not an indictment of them, but “an appeal to the manufacturers to differentiate the packaging of the vaccines,” Schabacker said. “Most of it was due to confusing labeling.”?

Human factors in operationalizing telehealth (#8)

Telemedicine usage exploded during the pandemic, and is still far above pre-pandemic numbers. But adoption has been uneven. Younger people like the convenience it offers, and also tend to be tech savvier.

For older adults and people with disabilities, however, the technology can be frustrating, or even impossible, to use, especially if they have vision or hearing difficulties, or have trouble handling the equipment. Lower-income and rural populations also tend to have less access to reliable internet.

“While telehealth might seem to be creating more equity, it’s actually the opposite,” Schabacker said. “I think we’re going to see a wave of people who’ve had delayed care or no care over the past two years.”

Telemetry monitoring (#10 on the list) also is an example of a technology that sounds good in practice but introduces new safety risks, according to ECRI. Administrators like the remote monitoring systems, Schabacker said, because they can free up valuable intensive care unit beds, while moving more stable patients to step-down units.

But telemetry devices have a high false alarm rate, leading to alarm fatigue. They also require investment in a hospital’s telecommunication network; hospitals might not even know where there are drop-out zones. And training happened very fast.

The Bottom Line

The pandemic isn’t the only driving force behind patient safety risks. The past two years have also brought heightened urgency to addressing bias and racism (#3) in medicine. Black patients are 60% more likely to face a safety risk than White patients with the same risk profile, according to Schabacker.?

“The data is so clear — so evident — and you would think if something is so evident, we should do something about it,” he said.

Yet solving these problems may seem like lofty goals given the pressures on hospitals today. Schabacker insists, however, that the first step to solving a problem is drawing attention to it. He pointed to President Biden earlier this month signing the Dr. Lorna Breen Health Care Provider Protection Act , which provides grants to hospitals so they can offer mental health services to clinicians.

“What we’re trying to do is get all the relevant players together,” Schabacker said. “The more attention we can draw to this, then eventually it gets enough traction.”