Becker's Hospital Review

38 CMO / CARE DELIVERY The less-discussed consequence of healthcare's labor shortage By Mackenzie Bean and Gabrielle Masson T he healthcare industry's staffing shortage crisis has had clear consequences for care delivery and efficiency, forcing some health systems to pause nonemergency surgeries or temporari- ly close facilities. Less understood is how these shortages are affecting care quality and patient safety. A mix of high COVID-19 patient volume and staff departures amid the pandemic has put hospitals at the heart of a national staffing shortage, but there is little national data available to quantify the shortages' effects on patient care. e first hint came in September from a CDC report that found healthcare-associated infections increased significantly in 2020 aer years of steady decline. Researchers attributed the increase to chal- lenges related to the pandemic, including staffing shortages and high patient volumes, which limited hospitals' ability to follow standard infection control practices. "at's probably one of the first real pieces of data — from a large scale dataset — that we've seen that gives us some sense of direction of where we've been headed with the impact of patient outcomes as a result of the pandemic," Patricia McGaffigan, RN, vice president of safety programs for the Institute for Healthcare Improvement, told Becker's. "I think we're still trying to absorb much of what's really hap- pening with the impact on patients and families." An opaque view into national safety trends Because of lags in data reporting and analysis, the healthcare industry lacks clear insights into the pandemic's effect on national safety trends. National data on safety and quality — such as surveys of patient safety culture from the Agency for Healthcare Research and Quality — can oen lag by several quarters to a year, according to Ms. McGaffigan. "ere [have been] some declines in some of those scores more re- cently, but it does take a little while to be able to capture those chang- es and be able to put those changes in perspective," she said. "One number higher or lower doesn't necessarily indicate a trend, but it is worth really evaluating really closely." For example, 569 sentinel events were reported to the Joint Commis- sion in the first six months of 2021, compared with 437 for the first six months of 2020. However, meaningful conclusions about the events' frequency and long-term trends cannot be drawn from the dataset, as fewer than 2 percent of all sentinel events are reported to the Joint Commission, the organization estimates. "We may never have as much data as we want," said Leah Binder, president and CEO of the Leapfrog Group. She said a main area of concern is CMS withholding certain data amid the pandemic. Previ- ously, the agency has suppressed data for individual hospitals during local crises, but never on such a wide scale, according to Ms. Binder. CMS collects and publishes quality data for more than 4,000 hospi- tals nationwide. e data is refreshed quarterly, with the next update scheduled to have been released in October. e update was set to include additional data for the fourth quarter of 2020. "It is important to note that CMS provided a blanket extraordinary cir- cumstances exception for Q1 and Q2 2020 data due to the COVID-19 pandemic where data was not required nor reported," a CMS spokes- person told Becker's. "In addition, some current hospital data will not be publicly available until about July 2022, while other data will not be available until January 2023 due to data exceptions, different measure reporting periods and the way in which CMS posts data." Hospitals that closely monitor their own datasets in more near-term windows may have a better grasp of patient safety trends at a local level. However, their ability to monitor, analyze and interpret that data large- ly depends on the resources available, Ms. McGaffigan said. e pan- demic may have sidelined some of that work for hospitals, as clinical or safety leaders had to shi their priorities and day-to-day activities. "ere are many other things besides COVID-19 that can harm pa- tients," Ms. Binder told Becker's. "Health systems know this well, but given the pandemic, have taken their attention off these issues. In- fection control and quality issues are not attended to at the level of seriousness we need them to be." What health systems should keep an eye on While the industry is still waiting for definitive answers on how staff- ing shortages have affected patient safety, Ms. Binder and Ms. Mc- Gaffigan highlighted a few areas of concern they are watching closely. e first is the effect limited visitation policies have had on families — and more than just the emotional toll. Family members and caregivers are critical players missing in healthcare safety, according to Ms. Binder. When hospitals don't allow visitors, loved ones aren't able to contrib- ute to care, such as ensuring proper medication administration or communication. Many nurses have said they previously relied a lot on family support and vigilance. e lack of extra monitoring may contribute to the increasing stress healthcare providers are facing and open the door for more medical errors. Which leads Ms. Binder to her second concern: A culture that doesn't always respect and prioritize nurses. e pandemic has underscored how vital nurses are, as they are present at every step of the care journey, she said. To promote optimal care, hospitals "need a vibrant, engaged and safe nurse workforce," Ms. Binder said. "We don't have that. We don't have a culture that respects nurses." Diagnostic accuracy is another important area to watch, Ms. McGaffigan said. Diagnostic errors — such as missed or delayed di- agnoses, or diagnoses that are not effectively communicated to the patient — were already one of the most sizable care quality challenges hospitals were facing prior to the pandemic. "It's a little bit hard to play out what that crystal ball is going to show, but it is in particular an area that I think would be very, very import- ant to watch," she said. Another area to monitor closely is delayed care and its potential con- sequences for patient outcomes, according to Ms. McGaffigan. Many Americans haven't kept up with preventive care or have had delays in accessing care. Such delays could not only worsen patients' health conditions, but also disengage them and prevent them from seeking care when it is available.

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