Becker's Clinical Quality & Infection Control

6 PATIENT SAFETY & OUTCOMES 5 top patient safety issues for 2023 By Mackenzie Bean and Erica Carbajal T he Becker's Clinical Leadership & Infection Control editorial team chose the following five patient safety issues for healthcare leaders to prioritize in 2023, presented below in no particular order, based on news, study findings and trends reported in the past year. 1. Rebuilding or strengthening a culture of safety. In 2023, hospitals and health systems will continue the important work of reinvigorating safety efforts and ensuring they have a strong culture of safety to improve metrics surrounding diagnostic errors, patient falls and other adverse outcomes. Overall, 67 percent of hospital staff members said patient safety in their unit or work area was "excellent" or "very good," according to the Agency for Healthcare Research and Quality's Surveys on Patient Safety Culture 2022 report. e report includes survey findings from more than 206,000 provider and staff respondents at 400 U.S. hospitals. Of 56 hospitals that submitted safety data to AHRQ in both 2021 and 2022, 51 percent saw staff members' patient safety ratings fall in 2022 and 25 percent saw their number of reported safety events rise. "As we head into 2023, increasing the reliability of our core safety practices and identifying innovative methods to achieve reliability are top priorities," Charleen Tachibana, DNP, RN, senior vice president and chief quality, safety, patient experience officer at Virginia Mason Franciscan Health in Seattle, told Becker's. 2. Staffing shortages. Since the start of the COVID-19 pandemic, staffing shortages have persisted as a top challenge for hospital leaders. Between 2019 and 2022, the nation's nursing workforce lost 100,000 people, marking the largest decline in 40 years, according to the American Hospital Association. e AHRQ's 2022 report on patient safety culture identified staffing and work pace as an area for hospitals to improve upon, with just half of respondents indicating there is "enough staff to handle the workload, staff work appropriate hours and do not feel rushed, and [that] there is appropriate reliance on temporary, float or PRN staff." roughout the year, hospitals have cut services to grapple with staffing shortages. Nurses have pointed to guaranteed nurse- patient ratios, flexible scheduling options and better pay as factors that would entice them to stay in bedside nursing. With burnout also remaining a top issue for healthcare workers, hospitals and health system leaders will continue to advance initiatives that support well-being and resilience, personal and professional development, and flexible scheduling into 2023 and beyond. 3. Capacity issues. Chronic staffing shortages, care delays from earlier in the pandemic and now, a severe respiratory virus season have placed significant strain on hospital capacity. Dozens of medical groups in a Nov. 7 letter to President Joe Biden said emergency room boarding — when admitted patients are held in the ED because no inpatient beds are available — has reached a "crisis point" and urged the administration to convene a summit of stakeholders from across the healthcare system to identify long- term solutions to ED boarding. Workforce shortages across post-acute care facilities have also been a key driver of hospital capacity issues by limiting hospitals' ability to make timely discharges. To mitigate capacity strain, hospital leaders will continue their focus on addressing workforce shortages, given how large of a role staffing plays in capacity-related issues. "ere is no access in the community for our long-length-of-stay patients who may have ongoing health challenges and cannot return to their original housing accommodations. is is an unprecedented situation facing healthcare systems in Oregon and across the nation," Krista Farnham, chief executive of Providence Portland, told e Oregonian in a November report. 4. Ingraining health equity into core safety work. e pandemic drew a stark spotlight on the many longstanding structural and systemic inequities that contribute to healthcare disparities in the U.S. As a result, many healthcare organizations have looked inward to identify institutional or structural factors that contribute to these disparities. Healthcare safety work is not immune from these structural inequities. A 2021 report from the Urban Research Institute found Black patients face worse safety outcomes Researchers find possible genetic cause for MIS-C By Erica Carbajal A study suggests there may be an underlying genetic cause for why some children develop a rare but serious inflammatory condition known as multisystem inflammatory syndrome, or MIS-C, after a COVID-19 infection. More than 9,000 MIS-C cases, including 74 deaths, have been reported to the CDC since the agency started tracking them in May 2020. A study published Dec. 20 in Science identified genetic mutations to the proteins OAS and RNase L that increased the inflammatory response in some immune cells. The mutations were found in five unrelated children with MIS-C. "That change can cause inflammation in multiple organs, including the heart, lungs, kidneys and gastrointestinal tract," Cleveland Clinic said in a news release on the findings. Cleveland Clinic researcher Robert Silverman, PhD, collaborated with a team at New York City-based Rockefeller University on the study. "We identified the mutations through analyzing DNA sequence data from MIS-C patients in comparison to other children who were infected with COVID-19 but did not contract MIS-C," Jean-Laurent Casanova, MD, PhD, who led the study with the Rockefeller team, said in the Dec. 20 news release. "One of the key research questions was whether increased virus multiplication or an exaggerated inflammatory response led to MIS-C in the cases with the mutations. Our results support the latter explanation." n

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