Each year during Patient Safety Week, the nonprofit ECRI Institute publishes a list of its Top 10 Patient Safety Concerns to support organizations in their efforts to proactively identify and respond to threats to patient safety. This year, the organization said that its list was created before the rapidly evolving COVID-19 disease outbreak occurred. Noting that the crisis is clearly among the top patient safety concerns of the year, ECRI is committed to helping organizations prepare and respond. It has developed an online COVID-19 outbreak preparedness center.
Here is this year’s list, which spans the continuum of care:
1. Missed and Delayed Diagnoses
2. Maternal Health across the Continuum
3. Early Recognition of Behavioral Health Needs
4. Responding to and Learning from Device Problems
5. Device Cleaning, Disinfection, and Sterilization
6. Standardizing Safety Across the System
7. Patient Matching in the Electronic Health Record
8. Antimicrobial Stewardship
9. Overrides of Automated Dispensing Cabinets
10. Fragmentation Across Care Settings
Several of these touch on EHRs, informatics-related issues, organizational challenges and care coordination. For instance, concerning missed and delayed diagnoses, the report notes that the “electronic health record (EHR) should be structured so that clinicians and staff can readily understand the story so far: the trajectory of the patient’s condition, examinations and tests that have been performed, diagnoses that have been considered, and more.”
The issue around standardizing safety across the system notes that as the expansion of health systems continues, organizations find themselves facing many settings with differing cultures, processes, and resources. “Many healthcare organizations that do not have the infrastructure of a large system are also expanding and grappling with the complexities of providing safe care,” the report says. “A merger may mark the first time an ambulatory or other facility comes under the umbrella of a larger organization. Such facilities often must build their resources from scratch and they may lack the framework and infrastructure of larger organizations. But standardized culture of safety principles must be emphasized, implemented, and supported in smaller sites just as they are in the larger parent organizations.”
Another key issue involves patient matching in the EHR. When matching is not successful, ECRI’s analysts point out, duplicate and overlay records are created, which can lead to errors that cause significant downstream safety effects.
Therefore, the report recommends that “strong matching practices should be applied in EHR systems, prescription drug monitoring programs (PDMPs), health information exchanges (HIEs), and other digital health technologies, to allow for the flow of correct patient information across the continuum of care.
Finally, the report identifies fragmentation across care settings as a major patient safety challenge for 2020 “because it can impede communication among a patient’s providers and interfere with care coordination. Breakdowns in care from a fragmented healthcare system can lead to readmissions, missed diagnoses, medication errors, delayed treatment, duplicative testing and procedures, and general patient and provider dissatisfaction.”
