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The 10 Biggest Risks to Patient Safety in 2019

By Jennifer Larson, contributor

Every physician recognizes the mantra to “Do no harm,” but they may not recognize the greatest risks in their daily work that can lead to patient harm.

Each year, the nonprofit ECRI Institute highlights a list of patient safety challenges that they feel pose the greatest risks to both providers and their patients. Topping this year’s list are diagnostic errors and improper management of test results in electronic health records, along with some familiar topics like physician burnout.

While ECRI’s 2019 list of patient safety concerns does not attempt to include every hazard that exists, it does highlight 10 key concerns—with the hope that organizations and clinicians will take stock of the issues that are problematic in their own care settings and consider plans to minimize them. 

“The most basic aspect of providing care is not doing any unintentional harm,” said William M. Marella, MBA, MMI, executive director of patient safety organization (PSO) operations and analytics for ECRI Institute.

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ECRI’s 2019 List: The Top 10 Patient Safety Concerns

1. Diagnostic stewardship and test result management using EHRs. The correct information for diagnosis, treatment and follow-up must be communicated clearly in the patient’s electronic health record

2. Antimicrobial stewardship in physician practices and aging services. Providers must combat antibiotic resistance by carefully determining if an antibiotic is actually appropriate for a patient. 

3. Practitioner burnout and its impact on patient safety. EHRs contribute to burnout, but the problem is much larger, and experts say the system must change to address this complex and growing problem. 

4. Patient safety concerns involving mobile health. Mobile health technology has opened up opportunities for better care, but also for risk, as healthcare providers must determine if patients can effectively use mobile devices as part of their care plans.

5. Reducing discomfort with behavioral health. Many healthcare systems may need to institute training to help caregivers learn to address behavioral health needs, as well as additional support systems.

6. Detecting changes in a patient’s condition. This problem can be particularly challenging during handoffs and care transitions. Training in communication and patient assessment can help, as well as training for responding appropriately to alarms.

7. Developing and maintaining skills. Simulations can help healthcare professionals learn and practice their skills, and simulation-based education has been shown to lead to better patient outcomes.

8. Early recognition of sepsis across the continuum.  Protocols should be used to facilitate timely diagnosis and management of sepsis, and information should be shared across the continuum of settings so healthcare providers can collaborate.

9. Infections from peripherally inserted IV lines. A greater awareness, coupled with routine surveillance and follow-up reporting, could reduce the risk of infections related to peripheral intravenous catheters. These infections often go underrecognized.

10. Standardizing safety efforts across large health systems. As consolidation and mergers of healthcare organizations continue, the challenge arises to find ways to institute effective structures to support processes that address patient safety needs.

It’s important for organizations to stay abreast of patient safety concerns and the impact they can and do have, noted Marella. And safety concerns encompass all care settings, not just acute-care hospitals.

“We did take special care this year to take a look at the applicability of these issues across the care continuum,” he said.

Download ECRI’s 2019 Top 10 Patient Safety Concerns: Executive Brief  for more details.

The hunt for better solutions

It’s been 20 years since the Institute of Medicine released its landmark To Err is Human report, which highlighted medical errors and system issues that can decrease patient safety. The country has seen a lot of progress since that time, but there is a lot of room left for improvement.

“The patient safety movement has shone a light on a lot of safety issues that I think people were aware of but weren’t aware of how prevalent they were,” said Marella.

ECRI leaders hope that calling attention to the top safety concerns every year will generate more attention to finding solutions.

For example, researchers note that prioritizing antimicrobial stewardship, ranked No. 2 on this year’s list, could have far-reaching effects. Antibiotic resistance has been named “one of the biggest threats to global health” by the World Health Organization (WHO), and is responsible for 23,000 deaths each year in the United States alone. Solutions will require managing patient expectations and thoughtful consideration of treatment options.

Antimicrobial stewardship is definitely an urgent problem, too, noted Helen Boucher, MD, FACP, FIDSA, an infectious disease physician at Tufts Medical Center and director of the new Tufts Center for Integrated Management of Antimicrobial Resistance (CIMAR).

“The crisis has reached the point to where it threatens medical care to which we’ve become accustomed,” said Boucher, noting that everything from surgery to chemotherapy to organ transplantation to care for premature babies is in jeopardy if antibiotic resistance is not addressed.

A team effort

ECRI’s 2019 list of top safety concerns provides an opportunity for patient safety officers to take these issues beyond their realm to the people on the front lines of care, as well as board members and other leaders.

“It has to be top-down and bottom-up to make progress,” said Marella. “You have to engage the front-line caregivers…but you often can’t make changes without the buy-in and support of key leadership.”

Improving patient safety really should be a team effort that includes all the players, noted Michael Ganio, PharmD, MS, director of pharmacy practice and quality for the ASHP. For example, pharmacists are medication experts, and they’re available to help address questions about medications from other healthcare professionals, as well as patients. 

“We’re all there to support each other and work together for the good of the patient,” said Ganio.

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