Racial and ethnic disparities in health outcomes and crisis preparedness are the top concerns for patient safety that health leaders need to address, according to ECRI's annual Top Ten Patient Safety Concerns for 2021.
This is the first time ECRI has made differences in how health systems treat people of color a top safety concern that poses the most risk for patients. The not-for-profit patient safety organization recommends that health systems create health equity governance committees, and devote money and other resources to organizational efforts to address disparities.
The first is to recognize and accept that there's an issue, and then to look at where the disparities are," said Dr. Marcus Schabacker, CEO of ECRI. "If you go to a CEO, or a chief medical officer and say, 'there's an issue in your hospital,' they'd say, 'No, we treat everybody the same.' You may think so, but the reality is different. There's a lot of things that contribute to this inequality, from explicit to implicit biases."
Health disparities are differences in health outcomes that are closely linked with social or economic disadvantage a population of people have faced typically because of discrimination or exclusion, according to HHS [https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities]. In the case of hospitals and other providers, the population at hand are patients. Despite the long-standing disparities, most health systems haven't addressed the issue directly within their walls.
Schabacker said this can look like a healthcare workforce that doesn't mirror a patient population.
"Typically at least on the physician side, we don't get the same representation as a lot of those diverse patient populations; there's an inherent risk of barrier right there," Schabacker said. "And we see it in maternity outcomes, we see it in stroke outcomes, we see it in pain management, we see it in heart disease. There are hardcore numbers there, so we need to attack that with real plans."
Nationwide, black adults are 50% more likely to have a stroke than white adults. ECRI recommends that health systems look at their own patient data for differences between race and ethnicities. Leah Binder, the president and CEO of patient safety organization The Leapfrog Group, said health systems need to train employees on implicit and explicit bias.
"Until we start talking about that in very candid and uncomfortable ways, we are not going to get at the deadly problems in quality and safety that we're seeing as a result of disparities," Binder said. "There's evidence that black people are less likely to get referred for immediate follow-up care to potential cancer diagnoses, which can be deadly."
Eight of ECRI's other concerns included issues related to pandemic preparedness, including supply chain disruptions, drug shortages, health system responses and improvised use of medical devices. The report points out that the COVID-19 pandemic exposed deep problems, from not having enough supplies in storage to patient surge capacity plans. Schabacker said now is the time for hospitals to take a step back and look at decision making and what could have been done better.
"If we improvised some usage of a transport ventilator, or put ventilators out in the hallway and infusion pumps out in the hallways, how did we arrive at those decisions?" Schabacker questioned. "And do we have the right mechanisms in place that if we ever get in a situation like that again, we have a better process to involve the right people in real time to make a better decision than we did."
Another pandemic-spurred concern was with the quick uptake of telehealth services in light of the need to keep patients in lower-risk settings like their home.
ECRI and the ISMP PSO reviewed a sample of 42 telehealth related events and found several evolving themes, including: inadequate language services, inappropriate or inadequate patient monitoring and privacy concerns.
"Hospitals really need to stay take a step back now that we aren't in total crisis mode anymore, and look at solid protocols around cybersecurity," Schabacker said, also noting that accessibility was a big issue for many patients who didn't have high-speed internet access or technology accessibility, which in turn stratifies the types of patients who can be cared for through telehealth.
Other action recommendations include monitoring expiration dates of PPE supplies such as N95 masks, and develop a comprehensive infrastructure plan that could include having backup plans for water and electricity outages, and maintaining isolation spaces.
For the first time in three years, diagnostic errors didn't make the list. Schabacker said they're aware that these errors didn't go away during the pandemic, and likely actually went up. But the lack of pandemic preparedness was so striking that ECRI chose to focus on basic crisis planning. Binder from The Leapfrog Group said ECRI should have just added an 11th concern.
"Patients are still dying from diagnostic errors, and they're considered one of the most significant problems for inpatient safety, period," Binder said.