ECRI on Monday released its list of the "Top 10 Patient Safety Concerns" for 2022, with staffing shortages and worker mental health concerns topping the list.

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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.

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For this year's list of top patient safety concerns, an interdisciplinary ECRI team, along with the Institute for Safe Medication Practices, reviewed and assessed topics nominated by ECRI experts to identify the top 10 issues for 2022 using the following criteria:

• Severity: How serious would the harm to patients be?
• Frequency: How likely is the safety concern to occur?
• Breadth: How many patients would the safety concern impact?
• Insidiousness: Is it difficult to recognize the problem or challenging to correct once it occurs?
• Profile: Would the safety concern place a lot of pressure on the organization?

Once identified, subject matter experts then developed recommendations aiming at addressing these issues.

ECRI's top 10 patient-safety concerns for 2022

1. Staffing shortages
2. Covid-19 effects on health care workers' mental health
3. Bias and racism in addressing patient safety
4. Vaccine coverage gaps and errors
5. Cognitive biases and diagnostic error
6. Nonventilator health care-associated pneumonia
7. Human factors in operationalizing telehealth
8. International supply chain disruptions
9. Products subject to emergency use authorization
10. Telemetry monitoring

Typically, ECRI's list focuses on clinical problems, such as diagnostic errors and cybersecurity attacks, Modern Healthcare reports. And while those concerns are still prevalent, the pandemic was a major disruption to health system operations over the past two years. 

For this year's list, several safety concerns reflected challenges that have emerged because of the stresses associated with care delivery during the Covid-19 pandemic. ECRI determined that staff shortages are the top patient concern because of concerns about access to care, disparities, and physician burnout.

"Even before the Covid-19 pandemic, there was a persistent shortage of clinical and nonclinical staff across the continuum. Staffing shortages have continued to increase throughout the pandemic," the ECRI report states.

"Shortages in the healthcare workforce and mental health challenges were broadly known and well-documented for years," said Marcus Schabacker, president and CEO of ECRI. "Both physicians and nurses were at risk of burnout, emotional exhaustion and depression prior to 2020, but the pandemic made both issues significantly worse."

To address staffing shortages, ECRI recommended that health systems assess the impact staffing ratios have on safety and quality outcomes. In addition, they recommended offering staff more flexible work hours, and using care extenders and map workloads for every shift.

Regarding the second most prevalent patient safety concern for 2022—the pandemic's effect on health care workers' mental health—ECRI cited a June 2021 survey that found that 20% of physicians had experienced burnout, with 6% saying they had experienced depression and 7% saying they had thoughts of suicide. ECRI also cited a February 2021 survey that found that 25% of critical care nurses experienced high levels of emotional exhaustion.

"An often discussed but inadequately addressed collateral result of the Covid-19 pandemic is the toll it has taken on the mental health of healthcare workers. Healthcare professionals' mental health was already at crisis level before the Covid-19 pandemic; both physicians and nurses were at risk of burnout, emotional exhaustion, or depression prior to 2020. The pandemic has now forced a reckoning with healthcare workers' mental health needs," the report said.

ECRI recommends health systems set a tone of personal connection and support practitioner wellness to enhance clinician resilience. (Gillespie, Modern Healthcare, 3/14; ECRI, "Top 10 Patient Safety Concerns 2022," accessed 3/15; Cheney, HealthLeaders Media, 3/14)