ECRI on Monday released its annual list of the 10 biggest patient-safety concerns in 2021. For the first time, racial and ethnic disparities were rated as the health safety issue posing the greatest threat to patients.

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How ECRI made the list

ECRI is a nonprofit organization that studies how to improve patient care by addressing safety concerns across the continuum of care.

For this year's list of top patient safety concerns, an interdisciplinary team reviewed and assessed topics nominated by ECRI experts to identify the top 10 issues for 2021. Subject matter experts then developed recommendations and tools aimed at addressing these issues.

According to ECRI, many of the issues in this year's list revolve around the novel coronavirus pandemic and the "entrenched problems" that it exposed. "By learning lessons from the pandemic, we can improve safety not just for this and future pandemics, but for all patient and resident care," the report stated.

ECRI’s top 10 patient-safety concerns for 2021

1. Racial and ethnic disparities in health care
2. Emergency preparedness and response in aging services
3. Pandemic preparedness across the health system
4. Supply chain interruptions
5. Drug shortages
6. Telehealth workflow challenges
7. Improvised use of medical devices
8. Methotrexate therapy
9. Peripheral vascular harm
10. Infection risk of aerosol-generating procedures

According to Modern Healthcare, this is the first time ECRI has identified racial and ethnic disparities in care as the health safety issue that poses the greatest threat to patients. To address these issues, ECRI advises health systems to establish health equity governance committees and fund organization-wide efforts to resolve racial and ethnic disparities.

The first thing organizations need to do is recognize and accept that racial and ethnic disparities exist, according to Marcus Schabacker, CEO of ECRI. "If you go to a CEO, or a chief medical officer and say, 'There's an issue in your hospital,' they'd say, 'No, we treat everybody the same.' You may think so, but the reality is different. There [are] a lot of things that contribute to this inequality, from explicit to implicit biases."

For instance, Schabacker pointed out that there can be problems when health care providers at an institution don't reflect the ethnic and racial breakdown of the patient population they serve. "Typically, at least on the physician side, we don't get the same representation as a lot of those diverse patient populations; there's an inherent risk of barrier right there," he explained. "And we see it in maternity outcomes, we see it in stroke outcomes, we see it in pain management, we see it in heart disease. There are hardcore numbers there, so we need to attack that with real plans."

This year's list was the first that didn't include diagnosis errors as a top concern. Schabacker noted that's not because the issue has gone away. Instead, the lack of pandemic preparedness was so severe that ECRI focused primarily on crisis planning and the issues exposed amid the pandemic, such as supply chain problems, cybersecurity concerns, and patient surge capacity planning issues.

And as hospitals emerge from the crisis of Covid-19, Schabacker urges them to revisit those issues to prepare for similar challenges in the future. "[D]o we have the right mechanisms in place that if we ever get in a situation like that again, we have a better process to involve the right people in real time to make a better decision than we did," he said (Gillespie, Modern Healthcare, 3/15; Shinkman, Healthcare Dive, 3/15; ECRI, "Top 10 Patient Safety Concerns 2021," accessed 3/16).