Becker's Clinical Quality & Infection Control

7 PATIENT SAFETY & OUTCOMES Viewpoint: Safety work relies too much on clinicians' heroism By Mackenzie Bean A national patient safety effort that standardizes best practices across all U.S. hospitals is required to achieve and sustain meaningful improvements in patient care, five patient safety experts said in a NEJM Catalyst article published Dec. 12. The pandemic erased years of progress in preventing healthcare-associated infections and other adverse clinical outcomes, though many experts were already sounding the alarm on a decline in national safety work before the pandemic hit. "The COVID-19 pandemic revealed that patient safety policy and practice has relied too heavily on the vigilance and heroism of clinicians, rather than the design of safe systems," the leaders wrote. They identified two key factors that contributed to a slip in patient safety performance: variable deployments of patient safety systems across healthcare organizations and high turnover rates among front-line clinicians fueled by burnout. To address these issues, the nation's patient safety organizations should unite with leading health systems to identify standardized best practices that could be adopted nationally, leaders wrote. Although this approach would not directly address staffing issues, it would "greatly reduce the learning burden that health professionals face when they move among care delivery settings," leaders said. n than white patients at the same hospitals. In 2023, many healthcare organizations will continue the crucial task of examining inequities regarding adverse clinical outcomes, including how they are reported on and addressed. Tom Jackiewicz, president of the University of Chicago Medical Center, said reviewing all quality and outcomes metrics with an eye toward diversity, equity and inclusion will be a top priority for the organization in 2023. "You can't fix what you don't see, which is why we're committed to diving deep into the datasets to identify inequities and health disparities," he said. "en we can develop plans and processes to close those gaps." 5. Healthcare-associated infections. In 2023, healthcare leaders will be tasked with implementing or strengthening efforts to prevent HAIs and sustain progress amid ongoing challenges with staffing and capacity. HAI rates increased significantly in 2020 aer years of steady decline due to various pandemic-related challenges, including staffing shortages and high patient caseloads, which impeded hospitals' ability to maintain standard infection prevention and control practices. CDC data published in November suggests this trend continued in 2021. Four of six regularly tracked HAIs increased last year by a range of 5 percent to 14 percent. Separate research published in Infection Control & Hospital Epidemiology found HAI rates rose and fell with COVID-19 surges in 2021. "ese findings … underscore the need to establish resilient approaches to reducing infections during times of system stress," said lead author Lindsey Lastinger, an epidemiologist at the CDC. n The cost of diagnostic errors in the ED: 5 study notes By Erica Carbajal A study led by the Agency for Healthcare Research and Quality that estimates 370,000 patients may suffer serious harm as a result of misdiagnosis in U.S. emergency departments every year is being met with strong criticism from medical societies representing emergency physicians, e New York Times reported Dec. 15. Researchers from Baltimore-based Johns Hopkins University worked with the AHRQ to analyze data from studies dating to 2000 to estimate the prevalence and effect of diagnostic errors in the ED. Many of the studies in the review were conducted outside of the U.S., in "developed countries deemed comparable by a technical expert panel," which has led many medical organizations in the U.S. to question the estimates. Five notes: 1. e study estimates that among 130 million ED visits per year in the U.S., 7.4 million patients are misdiagnosed and some 370,000 may suffer serious harm or death. 2. Serious diagnostic errors were more likely to occur when patients presented with atypical symptoms, such as stroke patients experiencing dizziness or vertigo. 3. Stroke, myocardial infarction, aortic aneurysm/dissection, spinal cord compression/injury and venous thromboembolism accounted for 39 percent of serious misdiagnosis-related harms. 4. Researchers found women and people of color were associated with between a 20 percent and 30 percent higher risk of misdiagnosis. 5. e study was met with criticism from the American College of Emergency Physicians, whose president called the conclusions "misleading, incomplete and erroneous," and said the reliance on studies conducted outside of the U.S. may have led to overestimates of mistakes. In a statement to the Times, the group's president, Christopher Kang, MD, said, "e report conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States," and, "While most medical specialties have similar training in Western nations, emergency medicine does not." n

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