New clinicians are having trouble transitioning to the workforce. Patients could pay the price, ECRI warns

Onboarding new graduates into healthcare has become more difficult following pandemic disruptions and will require greater attention and investment from the industry in order to stem preventable patient harm, ECRI warned in a new report.

Monday, the healthcare quality and safety group named challenges with transitioning newly trained clinicians as its top patient safety concern of 2024 and cited missed learning opportunities alongside increased workloads. The group also pointed to the broader healthcare workforce crisis, in which a large number of knowledgeable professionals—from whom greener clinicians could learn from—have departed the field, and a growing number of workers new and old who report experiencing burnout.

“Through no fault of their own, clinicians who started practicing medicine in the last several years didn’t have the same early experience as those who came before them–before the pandemic laid bare critical weaknesses in our healthcare system,” Marcus Schabacker, M.D., president and CEO of ECRI, said in a release. “ECRI’s top patient safety concern is a call to action to set new clinicians up for success through a 'total systems safety' approach and assess and redesign the environments in which clinicians are trained, onboarded, mentored and supported.”

Among the recommendations proposed by ECRI and its affiliate, the Institute for Safe Medication Practices (ISMP), in the report are new collaborative partnerships between healthcare and academic to support hands-on and simulation-based learning, as were wellness programs and adopting “a culture of safety that empowers newly trained clinicians to report safety events.”

Just behind new hire challenges in ECRI’s 2024 ranking was concern that healthcare staff’s workarounds for barcode medication administration systems could lead to an increase in medication safety events.

These workarounds occur when drug’s barcode can’t be scanned due to damage on a label, or when a medication hasn’t yet been added to an organization’s system, ECRI explained. This can lead to back-charting, proxy scanning, unlogged medication administration and ignored system alerts, and has historically been to blame for a majority of technology-related medication safety issues, according to the report.

Here, the group encouraged healthcare organizations to convene a multidisciplinary team to review why staff may turn to workarounds and to develop an escalation process for when a barcode will not scan. Further, organizations should reinforce that medications must be scanned prior to administration to providers and patients alike, with the latter being encouraged to speak up when their medication wasn’t scanned.

The full list of top patient safety concerns for 2024 in ECRI and ISMP’s ranked order was:

  1. Transitioning new clinicians from education to practice
  2. Workarounds with barcode medication administration systems
  3. Access to maternal and perinatal care
  4. Unintended consequences of technology adoption
  5. Physical and emotional well-being of healthcare workers
  6. Complexity of preventing diagnostic error
  7. Equitable care for people with physical and intellectual disabilities
  8. Drug, supply and equipment shortages
  9. Misuse of parenteral syringes to administer oral liquid medications
  10. Preventing patient falls

To build their list, ECRI and ISMP polled members and reviewed millions of logged patient safety events and other literature on patient safety to nominate several potential topics. A cross-disciplinary team of experts from the groups then ranked the nominees on the criteria of severity, frequency, breadth, insidiousness and organization pressure.

The list of concerns largely spoke to a single issue weighing down the entire healthcare industry, Schabacker noted.

“Many of our patient safety concerns for 2024 are exacerbated by a shortage of prepared healthcare clinicians,” he told Fierce Healthcare in an emailed statement. “Growing and properly supporting a well-trained healthcare workforce is central to improving safety for patients and providers.”

Another recent survey from ECRI fielded last year highlighted national medication, medical supply and medical equipment shortages as contributors to patient harm. These shortages, which are still ongoing and appeared on 2024's ranking, can delay treatments or keep providers from using optimally recommended therapeutics, the group warned.