While 2021 was a year of innovations in how care is delivered to adjust to the COVID-19 pandemic, big questions remain about how some of these changes are impacting hospital quality and safety.
Though the pandemic affected every community, many localities have shouldered a disproportionate share of COVID-19 hospitalizations, deaths and job losses. Those factors will need to considered when regulators determine how to measure hospital performance for the Medicare star ratings program, said Dr. Rishi Wadhera, a health policy researcher and assistant professor at Harvard Medical School.
"We need to think about how the broader context in terms of public health and economic shock affected the trajectory of outcomes in specific communities, and how that affects our assessment of how well hospitals are doing," Wadhera said.
For instance, Vizient data from its health system clients show that lower-acuity patients used emergency departments less and alternate sites more since the pandemic began, said David Levine, the supply chain management company's group senior vice president of advanced analytics and product management.
"If you have only the highest-acuity patients coming in, they're more apt to come back, and we definitely saw that in 2021," Levine said. "That will continue, and we haven't seen anything yet on what the Centers for Medicare and Medicaid [Services] are going to do to control for COVID-19 within their risk adjustment."
If CMS does factor COVID-19 effects into quality measurement, those changes likely will come within the next iteration of the inpatient prospective payment system proposed rules usually released in the summer.
Telehealth blew up during the height of the pandemic, despite utilization plateauing as in-person visits rebounded, health systems will begin to address safety and quality principles in 2022. Virginia Mason Franciscan Health has started monitoring telehealth quality through patient satisfaction surveys= and will look at other factors next year, said Charleen Tachibana, senior vice president and chief quality, safety and patient experience officer at the Seattle hospital, which is part of not-for-profit CommonSpirit Health.
"We have a lot of population health metrics that we can measure," Tachibana said. "If the management of that disease process is not evolving in the direction we'd want it to," the hospital could look at bringing patients back for in-person visits, she said.
More hospitals, mindful of the safety and quality risks associated with staff shortages and short-tenured or temporary workers, will use virtual nurses to provide second sets of eyes and guidance for frontline professionals, Tachibana said.
"You can't just put a new nurse into an unknown environment and expect them to know what they have to do. An experienced mentor will help you not to make any errors," said Dr. Brigitta Mueller, executive director for patient safety, risk and quality at ECRI.
The combination of incorporate new workers while maintaining a culture of safety during a chaotic time has affected hospital safety. Last year, hospital employees reported they feared punishment for reporting safety mistakes or speaking out about potential risks, according to a Press Ganey survey.
"My guess is that this worsening of safety culture scores continued in 2021 and will continue to have that downward trend because of all the stress that the system is under," said Tejal Gandhi, Press Ganey chief safety officer. "But there are best practices for improving safety culture, in terms of leadership behaviors, messaging on mission and making sure that they're being transparent."
ECRI also expects natural-language processing products will become the go-to way hospitals, accreditors and regulators will assess what led to adverse safety events by mining clinician notes, which is currently a manual process.
