ECRI’s Top 10 Patients Safety Concerns for 2023

Every year the ECRI Institute publishes a list of the most serious issues threatening patients and health workers safety.  The 2023 report recently came out and here is a summary of the top 10 patients safety concerns for 2023:

1. The Pediatric Mental Health Crisis

   The COVID-19 pandemic has highly impacted children’s mental health issues, with girls more likely to be diagnosed with anxiety and depression and boys with attention deficit disorders. Additionally, the CDC recorded a significant increase in emergency room visits for suspected suicide attempts by 12- to 17-year-olds in 2020 and 2021 compared to 2019. Unfortunately, it is estimated that only 40% of children suffering from depression receive treatment.
   Solutions to address this crisis should be part of a cultural change, with advocates and political leaders supporting this issue and pushing for the implementation of universal mental health screenings for pediatric patients during office or hospital visits. Healthcare workers should be supported when faced with the increase of mental health problems among young patients, and healthcare facilities should create new policies and procedures and train their staff on how to face this crisis.

2. Physical and Verbal Violence against Healthcare Staff

   With the exception of law enforcement, security professionals, and mental health workers, healthcare workers suffer from more workplace violence than any other profession. Among them, nurses are the most at risk, followed by technicians and physicians. Organizations must take measures to better protect their personnel by assessing the risks and taking adequate measures to reduce these types of events.

3. Clinician Needs in Times of Uncertainty Surrounding Maternal-Fetal Medicine

   Abortion bans in various states after the overruling of Roe vs Wade have created uncertainty among healthcare providers that can result in refusal or delays in care. Additionally, cross-border care complicates matters. Patients are at a higher risk of suffering serious harm, and healthcare providers are at higher risk of burnout with concerns related to maternal-fetal care adding to the post-pandemic stress.

4. Increasing risk of harm to patients caused by clinicians expected to work outside their scope of competencies

   Healthcare organizations have a legal duty to make sure that their staff performs within their scope of practice and verified competencies. Too many healthcare workers are assigned to tasks for which they have no competencies and for which they do not receive any training. On top of that, understaffing is rampant, and many workers have to work overtime. As a result, the risk of workplace violence and mental issues increases, leading to burnout  and adverse medical events.

5. Delayed Identification and Treatment of Sepsis
   

   Sepsis is the leading cause of hospital death, with 1.7 million Americans developing sepsis and 30% of them not surviving. Too often, sepsis is not timely diagnosed, and as a result, intravenous antibiotics are not immediately administered. Hospitals must develop and implement sepsis identification and treatment action plans to ensure timely identification and action plans.

6. Consequence of poor care coordination for patients with complex medical conditions

   Over 50% of the US population has chronic conditions, costing nearly $3.69 trillion per year and accounting for 90% of healthcare expenditures. Patients with multiple chronic conditions have higher healthcare utilization, worse outcomes, and are prone to preventable errors. Improved care coordination can help prevent these errors by addressing communication, health IT, medication reconciliation, test tracking, and care transitions.

7. Risks of Not Looking beyond the “Five Rights” to Achieve Medication Safety

   Adherence to the five rights (right patient, drug, dose, route, and time) in medication administration should be viewed as foundational goals rather than strategies for medication safety, and should be backed up by actionable procedures and high-leverage strategies to prevent errors.

8. Medication Errors Resulting from Inaccurate Patient Medication Lists

   Medication errors and adverse drug events are often caused by inconsistent knowledge and record-keeping about medications, with up to 50% of medication errors and 20% of adverse drug events being attributed to this issue. Discrepancies in medication reconciliation commonly occur during admission and discharge and can result in clinically significant and potentially life-threatening errors.
   Multidisciplinary medication reconciliation teams can improve the medication reconciliation process by reviewing current processes, identifying gaps and opportunities for improvement, and leading process design and redesign, with involvement from executive leadership, physician champions, pharmacists, IT personnel, and patient safety and quality staff.

9. Accidental Administration of Neuromuscular Blocking Agents

   Neuromuscular blocking agents (NMBs) have a well-documented history of causing catastrophic injuries or death when used in error, with up to 50% of wrong-drug errors involving NMBs not being the intended drug, and the majority of NMB errors resulted from administering or compounding a NMB instead of the intended drug. Common causes of NMB errors include look-alike packaging, labeling or drug names, dose or rate confusion, and orders entered into the wrong EHR.
   It is important to prevent NMB errors by using safety strategies such as labeling syringes, ensuring proper storage, and administering the medication only to patients who have ventilator support.

10. Preventable Harm Due to Omitted Care or Treatment

    Missed care opportunities, where necessary care is delayed, partially completed, or skipped entirely, are becoming more common in healthcare worldwide. Missed care can occur across a variety of healthcare specialties and settings. Inadequate staffing levels, increased workload, poor work environment, and limited resources are some of the most common predictors of missed care, along with poor communication, transitions of care, teamwork, and staff experience, education, or competency. Missed care can result in complications, delayed or omitted medications or treatments, increased length of stay, decreased employee satisfaction, and decreased patient satisfaction.

Download the ECRI Institute report