An old problem that's still a big problem is back as the No. 1 issue on ECRI’s list of the top 10 patient safety concerns for 2020.
Diagnostic errors—both missed and delayed diagnoses—topped the list. And a topic that’s been in the headlines this year—maternal health—was No. 2 on the list of patient safety hazards.
Last year, improper management of test results and inaccurate and missing information in electronic health records (EHRs) were at the top of the list of the annual report that highlights patient safety concerns across the continuum of care.
The independent, nonprofit organization released the report in conjunction with Patient Safety Awareness Week, March 8-14. It developed the list through a review of more than 3.2 million patient safety events. It intends for healthcare organizations to use the information to identify and mitigate patient safety hazards.
“Unsafe healthcare delivery harms millions of patients,” said Marcus Schabacker, M.D., president and CEO of ECRI. “Our annual patient safety report provides a roadmap to help healthcare leaders know what goes wrong and how to prevent harm.”
As well as relying on the analysis of patient safety events, the list is developed based on the judgment and experience of ECRI's interdisciplinary patient safety and medication safety experts. This list identifies areas that are high priorities for a variety of reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models and persistent issues that need focused attention or pose new opportunities for intervention.
Rounding out the list of patient safety concerns for 2020 are the following:
1. Diagnostic errors. The report said diagnostic errors are very common in healthcare settings, and missed and delayed diagnoses can result in patient suffering, adverse outcomes and death. Diagnostic errors are also the leading cause of liability claims against primary care doctors and account for the highest proportion of payouts, according to a separate report released earlier this year.
2. Maternal health. It is a patient safety issue across the continuum of care, the report found. Approximately 700 women die from childbirth-related complications each year in the U.S., with more than half of them preventable, according to data from the Centers for Disease Control and Prevention.
The U.S.’ dismal record on maternal and child health brought political awareness to the issue and calls to fix the jarring problem.
3. Early recognition of behavioral health needs. Stigmatization, fear and inadequate resources can lead to negative outcomes when working with behavioral health patients, the report said.
4. Responding to and learning from device problems. Incidents involving medical devices or equipment can occur in any setting where they might be found, including aging services, physician and dental practices and ambulatory surgery, according to ECRI.
5. Device cleaning, disinfection and sterilization. Sterile processing failures can lead to surgical site infections, which have a 3% mortality rate and an associated annual cost of $3.3 billion.
6. Standardizing safety across the healthcare system. Policies and education must align across care settings to ensure patient safety.
7. Patient matching in the EHR. Organizations should consistently use standard patient identifier conventions, attributes and formats in all patient encounters, the report said.
8. Antimicrobial stewardship. Overprescribing of antibiotics throughout all care settings contributes to antimicrobial resistance.
9. Overrides of automated dispensing cabinets. Overrides to remove medications before pharmacist review and approval lead to dangerous and deadly consequences for patients.
10. Fragmentation across care settings. Communication breakdowns result in readmissions, missed diagnoses, medication errors, delayed treatment, duplicative testing and procedures and dissatisfaction, ECRI said.