The 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. The 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 this year 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. The 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."
Throughout 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.
"There 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. This is an unprecedented situation facing healthcare systems in Oregon and across the nation," Krista Farnham, chief executive of Providence Portland, told The Oregonian in a November report.
4. Ingraining health equity into core safety work. The 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 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 next year.
"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. "Then 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 after 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.
"These 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.