ECRI: Top patient safety risks include inaccurate EHRs, clinician burnout

Improper management of test results and inaccurate and missing information in EHRs can lead to serious patient harm or death, according to ECRI. (Pornpak Khunatorn/Getty Images)

Improper management of test results and inaccurate and missing information in EHRs can lead to serious patient harm or death, leading the ECRI Institute’s list of the top 10 patient safety concerns for 2019.

The ECRI Institute, which bills itself as an independent nonprofit organization authority on medical practices and products, develops its annual list through a review of event reports and root-cause analyses from its members. It intends for hospitals to use the information in support of their individual efforts to identify and mitigate patient safety issues.

Providers have begun relying on the EHR to help with clinical decision support, to track test results, and to flag issues. However, if the data going into the EHR is bad then the information to providers will be bad, said Lorraine Possanza, program director at the  Partnership for Health IT Patient Safety: “Technology is just a tool—there’s currently not an algorithm that is going to identify all the key elements and analyze them to give you the correct diagnosis.”

Patricia Stahura, R.N., a senior analyst at the ECRI Institute, said the information must be accurate and must be written so that future clinicians looking at the EHR can understand it. “If you have faulty information or missing test results, you are predisposed to making a diagnostic error,” she said.

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ECRI cited antimicrobial stewardship in physician practices and aging services as the second biggest patient safety concern. Healthcare providers need to combat antibiotic resistance before the situation gets worse; as antibiotic resistance increases, physicians’ treatment options can be limited.

Perhaps the most significant challenge facing antibiotic stewardship is managing patient expectations, as patients expect an antibiotic to help them get better, the organization said.

“Antibiotic stewardship does not mean withholding necessary treatment,” according to Sharon Bradley, R.N., senior infection prevention and patient safety analyst at the ECRI Institute. “But we have casually and cavalierly handed around the candy dish of antibiotics without a second thought as to how we may be harming our patients.”

Study after study has indicated that clinician burnout has a consistent negative relationship with safety and quality, and now, it’s among ECRI’s top 3 patient safety concerns. EHRs are a contributing factor, the organization said, but burnout goes beyond providers’ oft-described frustrations with documentation.

“Reprioritizing what a clinician needs to do is one way to reduce burnout, but ultimately the system must change. If burnout is to be addressed effectively, organizations must listen to providers’ concerns about workload, performance criteria, and suboptimal resource allocation and fix these problems at a system level,” according to the report.

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The risks of mobile health technology occupied the fourth slot on the list, including lack of regulation of new technologies, barriers to ensuring that providers are accurately receiving the data and the potential for patients to use the technology incorrectly.

Healthcare providers need to address usability concerns and assess the device’s ease of use for patients as well as methods for informing clinicians about user error and inactivity. Most important is matching patient health conditions to the right piece of technology as well as assessing the likelihood the patient will accept mobile technology, the ECRI Institute said.

Other major concerns identified in this year’s list included reducing discomfort with behavioral health, detecting changes in a patient’s condition, skills development and standardizing safety efforts across large health systems.

The ECRI Institute also notes the need for early recognition of sepsis in other healthcare settings outside of the hospital, including aging services and physician practices. Healthcare workers throughout the continuum of care must be able to recognize sepsis, and physician practices should have protocols for the response when sepsis is suspected, much as they do for chest pain, according to the organization.

The list also highlighted the threat of infections from peripherally inserted IV lines. “Any time you break the skin, you’re breaking down the body’s first line of defense against infection,” said James Davis, R.N., senior infection prevention and patient safety analyst for ECRI.

Davis noted that tracing infections back to the PIV line can be difficult. If a patient gets both a peripheral line and a central line and later develops a bloodstream infection, clinicians will often attribute it to the central line without even considering the PIV line, he said.

Staff should assess whether a patient actually needs a PIV catheter inserted. Increased awareness of PIV-catheter-related infections can help reduce the risk, ECRI said.