10 top patient safety issues for 2021

The Becker's Clinical Leadership & Infection Control editorial team chose the following 10 patient safety issues for healthcare leaders to prioritize in 2021, presented below in no particular order, based on news, study findings and trends reported in the past year.

COVID-19. First referred to as a "mysterious pneumonia" in December 2019, the SARS-CoV-2 virus quickly spread across the globe, posing unprecedented challenges for hospitals. The first known COVID-19 death in the U.S. was documented Feb. 6. Since then, more than 330,000 additional Americans have died from the virus, according to data from Baltimore-based Johns Hopkins University. 

In early 2020, scientists worldwide raced to understand the virus, learning more about symptoms, transmission and antibodies every day. While clinicians now have a better understanding of how to treat the virus and the nation is in the early stages of vaccination, hospitals continue to grapple with capacity issues and supply shortages. Many health systems are also facing staffing shortages amid rising COVID-19 hospitalizations, making it increasingly difficult to provide quality care for all patients. 

Many routine care visits, elective procedures and routine childhood vaccinations have been delayed amid COVID-19 surges and shutdowns, leaving some patients without care for prolonged periods of time. Data has revealed continuing racial disparities linked to the virus, with a higher number of people of color exposed to, infected with and dying from COVID-19. The pandemic has also exacerbated other health inequities, underscoring the role social determinants of health play in patient outcomes. While the pandemic's full effect on patient care is still unknown, it is certain that the American healthcare system will be profoundly changed.  

Healthcare staffing shortages. The COVID-19 pandemic has exacerbated healthcare staffing shortages nationwide, as the virus sidelines thousands of employees who either contracted the virus or were exposed and must isolate. In mid-November, more than 1,000 hospitals nationwide reported serious staffing shortages, according to HHS data obtained by The Atlantic. In some parts of the U.S., staffing shortages have been so dire, some health systems have asked exposed employees to continue working if they are asymptomatic.

These staffing shortages, combined with a surge in COVID-19 hospitalizations, has led to increased nurse-patient ratios at many facilities, spurring many conflicts between nursing unions and hospitals in 2020. A 2017 study published in the International Journal of Nursing Studies showed every extra patient on a nurse's caseload increased mortality rates by 7 percent. Another study published in the Annals of Intensive Care found intensive care unit patients exposed to a high workload-to-nurse ratio for one or more days had lower risk-adjusted odds of survival to hospital discharge compared to patients exposed to normal ratios.

Missed and delayed diagnoses. Fear of contracting COVID-19 led to many people delaying both routine and emergency care this year. Across the oncology field, many people skipped out on screenings. Mammograms, for example, fell by 95 percent during the second week of April compared to the same period last year. 

Additionally, many oncologists have reported diagnosing higher proportions of advanced-stage disease compared to last year. This leads to more difficult treatment plans and higher death risks. The pandemic has also had a profound effect on cardiac care, with a June study showing 50 percent of heart attack patients delayed care.

Many patients have delayed seeking emergency care for health issues such as inflamed appendices, chest pain or bowel obstructions and often show up past optimal treatment window times. This has led to increased risks for complications and in some cases, unnecessary death. For instance, researchers believe a 20 percent jump in pediatric appendix rupture cases and increased mortality are linked to COVID-19-related fears.

To combat this issue, many healthcare systems are emphasizing their COVID-19 safety measures and advancing their telehealth services.  

Drug and medical supply shortages. Hospitals and health systems experienced remarkable supply shortages in 2020, which pose safety risks for patients and healthcare workers. The U.S. relies heavily on international suppliers like China for personal protective equipment, and imports significantly declined during the pandemic. 

Across the U.S., healthcare facilities have struggled to obtain enough PPE for staff members treating COVID-19 patients. Many clinicians have been forced to reuse masks or bring in their own PPE to protect themselves and patients. Amid this spring's COVID-19 surge, some nurses in New York recorded themselves working in plastic garbage bags because systems ran out of gowns. Scammers selling counterfeit PPE also created numerous obstacles for health systems attempting to protect employees and prevent transmission of the virus within their facilities. 

As of June, the U.S. was facing shortages of more than 200 generic drugs and supplies due to international shutdowns linked to the pandemic. In November, the American Medical Association declared drug shortages an urgent public health crisis and updated its approach to mitigating the shortages. Many drugs in shortage are commonly required for routine patient care and ventilator support, threatening basic care quality and patient safety.

Low vaccination coverage and disease resurgence. The pandemic has significantly disrupted routine vaccinations, with millions of U.S. children missing out on immunizations for preventable diseases such as measles, mumps, rubella and polio, among others. Public health officials are worried that if current trends continue, diseases that have nearly been eradicated could once again become a threat. 

More than 100 million children may miss out on measles vaccinations worldwide, estimates show. In 2019, global measles cases hit a 23-year peak with 869,770 cases and 207,500 deaths. UNICEF and the World Health Organization also warned of a potential polio resurgence within 10 years, and called for emergency funds to address immunity gaps and ramp up global vaccination campaigns. 

With so many testing supplies dedicated to COVID-19, U.S. labs are also facing a shortage of supplies needed to test for sexually transmitted infections and other common diseases like strep throat and pneumonia. Public health experts said inadequate testing could lead to skyrocketing infection rates, since many undiagnosed people may unknowingly spread STIs.

Clinician burnout. Clinician burnout has long been a problem in healthcare, prompting concerns about how it affects patient safety and care quality — and the unprecedented pressure brought on by the pandemic has pushed burnout to record high levels for many clinicians. 

In a nationwide survey from August, 58 percent of physicians expressed feelings of burnout, an increase from 40 percent in 2018. A separate survey in October found 72 percent of emergency physicians are experiencing more burnout at work. Notably, few physicians who said they experienced burnout sought help, both surveys found. Respondents cited several reasons they were reluctant to seek mental health support, including stigma at work. 

Experts recommend several strategies to curb physician burnout, including a reduction in administrative tasks and fostering an organizational environment that supports well-being. A recent study also found that a workplace mindfulness program significantly reduced healthcare professionals' burnout. 

Health equity. While health systems paid close attention to social determinants of health and patient outcomes before 2020, the COVID-19 pandemic has drawn a stark spotlight on many inequities that have contributed to healthcare disparities for years. This year, many healthcare organizations launched efforts to address COVID-19's disproportionate effect on people of color, as numerous studies show racial and ethnic minority populations are at higher risk of contracting and dying from the virus.

In July, the CDC issued a strategy document pledging steps toward reducing COVID-19 disparities and achieving health equity. Some analytic companies are partnering with healthcare systems to identify and examine how social and economic factors affect patient health. Federal health agencies and individual healthcare systems are also committing to address social inequities as a population-specific public health measure so they can better understand and care for the patients in their community. These efforts will maintain importance in 2021 and beyond. 

Healthcare-associated infections. CMS suspended HAI reporting requirements through June, allowing infection preventionists to shift their focus to COVID-19 emergency response activities. As a result, these leaders have spent less time on HAI surveillance and prevention efforts in 2020, and many have said they've seen an uptick in HAIs at their facilities since the pandemic's start, according to a Dec. 3 survey from the Association for Professionals in Infection Control and Epidemiology.

While it is still too early to fully assess how this shift will influence HAI incidence at hospitals nationwide, researchers noted large jumps in some infections at Mount Sinai Morningside in New York City and Christian Hospital in St. Louis this summer. Mount Sinai Morningside saw a 420 percent increase in central line-associated bloodstream infection rates during the pandemic compared to the prior 15 months, while Christian Hospital reported a 324 percent jump. COVID-19 patients are at higher risk of CLABSI, so researchers said they expect this rate to rise the most of all HAIs amid the pandemic.

Surgical mistakes. Surgical mistakes such as retained foreign objects or wrong-site surgery are rare, but can pose severe consequences when they occur. Most healthcare organizations postponed or canceled elective surgeries amid COVID-19 surges this spring and fall. Hospitals will likely have a large backlog of elective surgeries they must complete safely and efficiently in 2021 once the current virus surge wanes. A strong focus on surgical safety protocols will be key as hospitals ramp up surgical volumes.

In April, the American Hospital Association, American College of Surgeons, American Society of Anesthesiologists and Association of periOperative Registered Nurses published a road map for how to safely resume elective procedures and provide surgical care during the pandemic. The road map was most recently updated in November to include special considerations for hospitals struggling with capacity restraints.

Standardizing safety efforts. The COVID-19 pandemic has done little to deter healthcare mergers and acquisitions this year and may actually serve as a catalyst for these strategic partnerships moving forward, according to an October report from Kaufman Hall. Nineteen healthcare mergers and acquisitions were announced in the third quarter of 2020, up from 14 transactions in the second quarter of this year, the report found. 

Hospital mergers, acquisitions and divestitures cause various changes in an organization's culture, leadership, equipment and operating environment that can pose a threat to patient care. As health systems continue to expand their footprints, they must prioritize efforts to standardize safety processes and culture across every healthcare setting under their umbrella, including ambulatory and long-term care facilities.

Editor's note: This article was updated Dec. 30 at 4:26 p.m. CST.

More articles on patient safety and outcomes:
Safety board halts high-dose blood thinner trial for severe COVID-19 patients
Why healthcare leaders should stop overlooking nutrition in the quest for better outcomes: 4 insights
COVID-19 viral load may predict patient outcomes, study suggests


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