Becker's Clinical Quality & Infection Control

19 PATIENT SAFETY & OUTCOMES 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. Reinvigorating safety work: Where to start Ms. McGaffigan suggests healthcare organizations looking to reinvig- orate 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 sys- tems, 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 approach to their safety work, by focusing on the following 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 patient safety, but it's not an area that's systematically measured or evaluated, 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 on extra work and stress for their staff. Safety performance can slip when team members get busy or burden- some work is added to their plates, according to Ms. McGaffigan. She said leaders should be able to identify and prioritize the essential val- ue-added work that must go on at an organization to ensure patients and families will have safe passage through the healthcare system and that care teams are able to operate in the safest and healthiest work environments. In short, leaders should ask themselves: "What is the burdensome work people are being asked to absorb and what are the essential el- ements that are associated with safety that you want and need people to be able to stay on top of," she said. 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 recent- ly redesigned 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, noting that 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 concluded. "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 avail- able. 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 something 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 WHO releases official clinical definition for post COVID-19 By Erica Carbajal T he World Health Organization released a clinical definition of post COVID-19 illness Oct. 6 that was developed by patients and researchers. "Post COVID-19 condition occurs in individuals with a histo- ry of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of COVID-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis," the definition says. "Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 epi- sode or persist from the initial illness. Symptoms may also fluctuate or relapse over time." This is the first version of the definition and it may change over time as new evidence emerges, the WHO said. Estimates on the number of COVID-19 patients who experi- ence symptoms after their initial infection has cleared range from 10 percent to 30 percent. n

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