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March 15, 2017

The 10 biggest patient-safety issues, according to ECRI

Daily Briefing

    Information management in EHRs and patient deterioration issues are among the top patient-safety concerns for health care organizations this year, according to an annual report from the ECRI Institute.

    ECRI is a not-for-profit organization that studies patient safety issues. Since 2009, ECRI has collected over 1.5 million adverse-event reports from over 1,000 hospitals.

    This week, the organization's panel of safety analysts released ECRI's top 10 safety concerns based on more than 7,600 reports made to its adverse event reporting system.

    According to ECRI, the top 10 patient-safety concerns for health care organizations are:

    1. Information management in EHRs;
    2. Unrecognized patient deterioration;
    3. Implementation and use of clinical decision support;
    4. Test result reporting and follow-up;
    5. Antimicrobial stewardship;
    6. Patient identification;
    7. Opioid administration and monitoring in acute care;
    8. Behavioral health issues in non-behavioral-health settings;
    9. Management of new oral anticoagulants; and
    10. Inadequate organization systems or processes to improve safety and quality.

    This year's top patient-safety concern—information management in EHRs—is partly caused by the explosion of health care data in recent years, which brings new challenges for providers parsing through the data. Lorraine Possanza, program director for ECRI's Partnership for Health IT Patient Safety, said, "The object is still for people to have the information that they need to make the best clinical decision," but she added, "Health information needs to be clear, accurate, up-to-date, readily available, and easily accessible."

    Catherine Pusey, associate director of ECRI Institute PSO, said, "The 10 patient-safety concerns listed in our report are very real." She added, "They are causing harm—often serious harm—to real people."

    How hospitals can address patient safety concerns

    William Marella, executive director of ECRI's patient safety organization operations and analytics, said technology could help reduce patient misidentification, such as by incorporating patient photos in EHRs, simplifying patient identification documents, and scanning patient wristbands. According to Marella, hospitals could also reduce misidentification by "training providers not to refer to patients by their room number, which can change during their hospital stay," Modern Healthcare reports.

    ECRI also called on providers to establish protocols aimed at de-escalating behavioral health situations in non-psychiatric areas of the hospital. Nancy Napolitano, an ECRI patient-safety analyst, said hospitals should provide training on de-escalation policies, even if a hospital does not have a dedicated psychiatric unit. "Our health care industry is very reactive to violence as opposed to being proactive," Napolitano said. "You can expect violence, but you don't have to tolerate it."

    In other cases, ECRI said providers can improve patient safety by expanding existing best practices. Patricia Neumann, a senior patient safety analyst and consultant at ECRI Institute, noted that improved clinical protocols, training, and public awareness campaigns have helped providers more quickly recognize and respond to patient deterioration, such as heart attacks and strokes.

    "What if those same principles could be applied to other conditions that require fast recognition and management?" Neumann asked. "We could have a big impact on improving outcomes" (Rubenfire, Modern Healthcare, 3/13; Commins, Health Leaders Media, 3/13; Punke, Becker's Infection Control & Clinical Quality, 3/13).

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