Managing Test Results in EHR Tops ECRI Institute’s Patient Safety Top 10 List

Each year the ECRI Institute, a nonprofit patient safety organization, highlights its top 10 patient safety concerns. As in previous years, several of the concerns have technology-related themes, including this year’s No. 1 concern: Diagnostic stewardship and test result management using EHRs.

Here is the complete list of ECRI’s 2019 Top 10 Patient Safety Concerns:

1. Diagnostic Stewardship and Test Result Management Using EHRs

2. Antimicrobial Stewardship in Physician Practices and Aging Services

3. Burnout and Its Impact on Patient Safety

4. Patient Safety Concerns Involving Mobile Health

5. Reducing Discomfort with Behavioral Health

6. Detecting Changes in a Patient’s Condition

7. Developing and Maintaining Skills

8. Early Recognition of Sepsis across the Continuum

9. Infections from Peripherally Inserted IV Lines

10. Standardizing Safety Efforts across Large Health Systems

During a June 20 webinar, ECRI officials delved into detail on the 10 topics and highlights from their report on the subject. Several touch on issues important to Healthcare Innovation’s clinical, administrative and IT readership.

Diagnostic Stewardship and Test Result Management Using EHRs

The ECRI Institute report noted that the diagnosis, treatment plan and follow-up plan must be clearly communicated in the EHR. Faulty or missing information or test results definitely impacts patient safety. During the webinar, Patricia Stahura, R.N., M.S.N., a senior analyst and consultant for ECRI Institute, said not having the right information in a timely manner delays diagnosis and could result in improper diagnosis and unnecessary treatment, a concerning patient safety risk.

“We need to consider individuals working with the system and the work flow for test results management in the EHR,” she said. When results hit the inbox, is it overflowing? Electronic notifications are great, but our systems can be fragmented with multiple providers and specialists.” She said transitions of care can be a challenge. Health systems should re-evaluate how pending emergency department labs get followed up by the primary care provider, for instance. “Test results are critical to diagnosis. They can be dropped or not available to the next provider. Consider people, processes and technology,” she said.

Burnout’s Impact on Patient Safety

Another key issue in the report is one often tied to EHR optimization: physician burnout. The report notes that burnout affects physicians (including trainees), nurses, allied healthcare providers, and organizational leaders alike. During the webinar, Ellen S. Deutsch, M.D., M.S., medical director of the ECRI Institute, said that clinicians often struggle with resource constraints under which they are unable to provide the high-quality care they are capable or and patients deserve. She described the situation as “morally exhausting.”

Burnout has a constellation of symptoms, including decreased productivity. The suicide rate among physicians is the highest among any profession, she said. It is an important patient safety concern. She suggested health systems listen to providers and make systemic changes. “It should be an organizational priority and all of us can help.” The report notes that “the electronic health record is a contributing factor, but burnout goes beyond providers’ oft-described frustrations with documentation.”

Patient Safety Concerns Involving Mobile Health

Stephanie Uses, Pharm.D., J.D., a patient safety analyst and a consultant to ECRI Institute, noted that there is a lot of enthusiasm about mobile health but added there are some risks associated. Mobile health apps are lightly regulated. She said providers need to focus their efforts to make sure the patient is using the technology correctly or even using it at all. More effort needs to be taken to identify the right candidates for mobile health and to train the patients and their families on their use.

Standardizing Safety Efforts across Large Health Systems

As health systems get bigger through mergers and acquisitions, ECRI Institute recommends that they prioritize focusing on building a common culture of patient safety. “Regardless of organization size, the goal is to institute structures that effectively allow patient safety leaders to support organization leadership in engaging with patient safety priorities,” its report notes. Foundational principles of continuous communication up and down the chain of command, clear organizational structure, consistent committee configuration, and universal strategic planning and implementation can help the organization reduce inconsistencies and embed a strong focus on patient safety.”

Here is ECRI Institute's 2018 list of patient safety concerns:

1. Diagnostic errors
2. Opioid safety across the continuum of care
3. Care coordination within a setting
4. Workarounds
5. Incorporating health IT into patient safety programs
6. Management of behavioral health needs in acute care settings
7. All-hazards emergency preparedness
8. Device cleaning, disinfection, and sterilization
9. Patient engagement and health literacy
10. Leadership engagement in patient safety