Becker's Hospital Review

39 FINANCE CMO / CARE DELIVERY Reinvigorating safety work: Where to start Ms. McGaffigan suggests healthcare organizations looking to reinvigo- rate their safety work go back to the basics. Leaders should ensure they have a clear understanding of what their organization's baseline safety metrics are and how their safety reports have been trending over the past year and a half. "Look at the foundational aspects of what makes care safe and high quality," she said. "ose are very much linked to a lot of the systems, behaviors and practices that need to be prioritized by leaders and effectively translated within and across organizations and care teams." She recommended healthcare organizations take a total systems ap- proach to their safety work by focusing on four interconnected pillars: • Culture, leadership and governance • Patient and family engagement • Learning systems • Workforce safety For example, evidence shows workforce safety is an integral part of pa- tient safety, but it's not an area that's systematically measured or eval- uated, according to Ms. McGaffigan. Leaders should be aware of this connection and consider whether their patient safety reporting systems address workforce safety concerns or instead add extra work and stress for their staff. Safety performance can slip when team members get busy or bur- densome work is added to their plates, according to Ms. McGaffigan. She said leaders should be able to identify and prioritize the essential value-added work that must go on at an organization to ensure pa- tients and families will have safe passage through the healthcare sys- tem and that care teams are able to operate in the safest and healthiest work environments. In short, she said leaders should ask themselves, "What is the burden- some work people are being asked to absorb, and what are the essential elements that are associated with safety that you want and need people to be able to stay on top of ?" To improve both staffing shortages and quality of care, health systems must bring nurses higher up in leadership and into C-suite roles, Ms. Binder said. Giving nurses more authority in hospital decisions will make everything safer. Seattle-based Virginia Mason Hospital rede- signed its operations around nurse priorities and subsequently saw its quality and safety scores go up, according to Ms. Binder. "If it's a good place for a nurse to go, it's a good place for a patient to go," Ms. Binder said, noting that the national nursing shortage isn't just a numbers game; it requires a large culture shi. Hospitals need to double down on quality improvement efforts, Ms. Binder said. "Many have done the opposite, for good reason, because they are so focused on COVID-19. Because of that, quality improve- ment efforts have been reduced." Ms. Binder urged hospitals not to cut quality improvement staff, not- ing this is an extraordinarily dangerous time for patients, and hospitals need all the help they can get monitoring safety. Hospitals shouldn't start to believe the notion that somehow withdrawing focus on quality will save money or effort. "It's important that the American public knows that we are fighting for healthcare quality and safety — and we have to fight for it, we all do," Ms. Binder said. "We all have to be vigilant." Conclusion e true consequences of healthcare's labor shortage on patient safety and care quality will become clear once more national data is available. If the CDC's report on rising HAI rates is any harbinger of what's to come, it's clear that health systems must place renewed focus and energy on safety work — even during a situation as unprecedented as a pandemic. e irony isn't lost on Ms. Binder: Amid a crisis driven by infectious disease, U.S. hospitals are seeing higher rates of other infections. "A patient dies once," she concluded. "ey can die from COVID-19 or C. diff. It isn't enough to prevent one." n What researchers found reviewing 250,000 long COVID-19 cases By Erica Carbajal M ore than half of COVID-19 survivors experience at least one symptom six months or more after initially recovering from the illness, a systematic review in- volving 250,351 COVID-19 survivors found. The findings were published Oct. 13 in JAMA Network Open and are based on a systematic review of 57 studies. Of the 250,351 people included in the studies, 56 percent were men and 79 percent were hospitalized during their initial COVID-19 infection. The median proportion of people experiencing at least one symptom one month after their initial infection was 54 per- cent, based on 13 of the studies. At two to five months af- ter infection, 55 percent of people experienced at least one symptom (38 studies) and about 54 percent still had at least one symptom six months or more after their initial recovery (nine studies). Four studies found 62.2 percent of COVID-19 survivors had abnormalities on chest imaging, the most prevalent pulmo- nary symptom. Meanwhile the most common neurologic symptom was dif- ficulty concentrating, experienced by nearly 24 percent of people across four studies. The findings also identified gen- eralized anxiety disorder (29.6 percent) as the most com- monly reported mental health symptom in seven studies. General functional impairments (44 percent across nine studies) were the most common functional mobility symptoms, and fatigue or muscle weakness (37.5 percent across 30 studies) was the most common general and constitutional symptom. "These findings suggest that [post acute sequelae of COVID-19] is a multisystem disease, with high prevalence in both short-term and long-term periods. These long-term PASC effects occurred on a scale sufficient to overwhelm existing health care capacity, particularly in resource-con- strained settings," researchers said. "Moving forward, cli- nicians may consider having a low threshold for PASC and must work toward a holistic clinical framework to deal with direct and indirect effects of SARS-CoV-2 sequelae." n

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