ECRI institute’s top 10 patient safety concerns highlights a dysfunctional healthcare system

Every year the ECRI institute releases a list of top main concerns that may lead to patient harm and medical malpractice. While cybersecurity was one of the main concerns in the previous years, the ongoing Covid 19 crisis put a lot of pressure on hospital staffing and “staffing shortages” is now at the top of the concerns  followed by worker’s mental health and racial disparity in treatments.

The pandemic emphasized concerns that were already latent in the American healthcare system but that have worsened during the pandemic:

1. Staffing shortages: the registered nurses median age is 52 year old with 20% of them being older than 65 year old. Young nurses are needed but nursing schools are missing proper resources such as faculty, clinical sites, classroom spaces and budget. As a result 80,407 nursing school applicants were turned down in 2019.  In the coming years, staff shortages will be experienced at all levels of the healthcare system from nursing assistants to technicians such as laboratory technicians as well as critical care doctors, hospitalists, pharmacists and respiratory therapists.
2. Covid19 effects on healthcare workers’ mental health: the ongoing pandemic is putting a major strain on workers. A survey conducted last summer found that 20% of healthcare workers are experiencing burnout, almost 30% were previously treated for depression or anxiety, another 6% experienced depression and 7% have suicidal thoughts. While some workers experienced a positive psychological change following the stressful circumstances of the pandemic many of them are psychologically exhausted especially those dealing directly with Covid19 patients or working in critical care units. Healthcare workers also report poor quality sleep, high anxiety, trauma and unintended negative memory.
3. Bias and racism in access to healthcare and outcomes: a direct consequence of the above concerns is that disparities are increasing in the way people receive medical attention. While racial and ethnic minority groups are more likely to suffer from medical malpractice, they are also less likely to report it. A study found that a black patient with the same insurance coverage and treated in the same hospital as a white patient of the same gender has a much higher risk of suffering an adverse event.
4. Vaccine coverage gaps and errors: vaccine success relies on widespread administration. While 94% of children are vaccinated for polio, only 62% of the US population is vaccinated for Covid19 and as a result new Covid19 strains are continuing to appear.  On the top of it the ECRI institute reports that vaccine errors are quite frequent: 23% of people getting a vaccine are administered the wrong vaccine, 19% the wrong dose, another 19% received an expired or contaminated vaccine and a 8% got their vaccine at a wrong interval.
5. Cognitive biases and diagnostic errors: too many patients showing respiratory symptoms are suspected to have Covid19 even after a negative test and as a result the following conditions are often misdiagnosed: Aseptic meningitis, disseminated coccidioidomycosis, pneumonia caused by fungal infection, lemierre’s syndrome, lyme disease and other tick-borne illness and mitral valve regurgitation .
6. Non-ventilator Healthcare Associated Pneumonia: pneumonia is the most common healthcare associated infection and while a lot of emphasis was put on ventilator-associated pneumonia, 65% of  the patients who contracted pneumonia in healthcare settings were non-ventilator associated cases compared to 35% of ventilator associated cases
7. Overlooking human factors in telehealth operations: telehealth is still new and experimental and as a result a lot of bugs and system failures still occur that can result in harm to patients
8. International supply chain disruptions: some drugs and healthcare supply shortages are occuring because of the ongoing pandemic. For example it now takes up to 3 months to obtain heart defibrillators while before the pandemic it would take 2 weeks.
9. Products subject to emergency use authorization: every time the FDA issues emergency use authorization (EUA) for drugs, devices, or biologics for serious diseases or conditions it lowers the levels of evidence of safety and efficacity of theses products.
10. Telemetry monitoring: errors in telemetry monitoring can be especially dangerous when it comes to patients with cardiac issues

Read the entire report here