6 quality leaders on the safety issues they're prioritizing in 2021

In recognition of Patient Safety Awareness Week, Becker's asked six hospital and health system quality leaders to share the patient safety issues they are prioritizing this spring and beyond.

All respondents shared their insights with Becker's via email or phone March 11-17. Responses were lightly edited for clarity and length. They are presented alphabetically.

Question: What patient safety issue are you placing renewed focus on this year? 

Jason Adelman, MD. Chief Patient Safety Officer, Associate Chief Quality Officer and Executive Director of the Center for Patient Safety Research at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (New York City). As the pandemic starts to wind down, we can reflect on patient safety lessons learned during the crisis, while also refocusing on basic patient safety. Telehealth rapidly expanded during the pandemic, requiring more attention to telehealth-related diagnostic errors. Efforts dedicated to improving patient safety culture were diverted to address staff burnout and need to be reinvigorated. Initiatives aimed at preventing falls, hospital-acquired infections and sepsis were complicated by the unique challenges of the pandemic, and need to be redirected back toward core principles of high reliability. It is premature to say COVID-19 is behind us, but we need to pick up the initiatives that were stalled by the pandemic, and address the safety issues resulting from the new workflows and care modalities introduced by COVID-19 that are here to stay.  

Carol Barsky, MD. Chief Quality and Value Officer at Dartmouth-Hitchcock Health (Lebanon, N.H.). This year, I am placing renewed focus on utilizing our front-line healthcare workers' observations and concerns to guide improvement priorities, and therefore improved outcomes, for all of our patients. As we transition into more stable times, we need to continue to ask our healthcare workers, "How can I help you?" and prioritize their physical, emotional and mental well-being to prevent burnout.

Rollin J. (Terry) Fairbanks, MD. Vice President of Quality and Safety at MedStar Health (Columbia, Md.). At MedStar Health, we strive to take a proactive approach to patient safety, identifying and mitigating issues proactively before they can reach a patient. To that end, a special focus this year will be on deploying our human factors safety reviews, using failure mode and effects analysis, and leveraging our patient safety reporting system to identify areas that will benefit from the most attention. We will continue our work with patients and families to learn from their experiences receiving healthcare and use this information to guide our work. Finally, we continue to emphasize the importance of integrating human factors engineering and system safety principles into our proactive safety work in order to optimize safety for our patients.

Lorraine Hutzler, MPA. Associate Program Director of the Center for Quality and Patient Safety at NYU Langone Health (New York City). At the forefront is to ensure our patients are safe and comfortable coming into the hospital. We can't resume our cases unless they're comfortable, and they know they're in the best stance to move forward. Hospital-acquired conditions and infections, those are something we always want to prevent, but now more than ever. It's something that we can't forget about even though COVID-19 is still out there.

Last year in January and February, before we really knew COVID-19 was around, we had a tremendous uptick in hospital-acquired conditions just during that quarter, and it obviously leveled out later on. But we found during that time, there was probably an increased [venous thromboembolism] rate in orthopedic patients that we didn't know had COVID-19, because we're seeing patients who had COVID-19 are more susceptible to clotting, and so the virus was probably out there sooner than we knew.

Mark P. Jarrett, MD. Senior Vice President, Chief Quality Officer and Deputy CMO at Northwell Health (New Hyde Park, N.Y.). A lesson learned from the last year was the importance of standardizing treatment protocols. Care of the critically ill COVID-19 patients across our hospitals improved as we ensured best practices are adopted by all, such as proning. In addition, establishing standardized guidelines for medical therapies in a rapidly shifting "knowledge" environment was clearly demonstrated. These experiences are now being embedded in our routine non-COVID-19 care. Physician buy-in is much easier as they have seen the benefits of such standardization. The impact on quality and safety we believe will be significant.

Barbara Pelletreau, RN. Senior Vice President of Patient Safety at CommonSpirit Health (Chicago.). The most important thing we can do as a healthcare system is to make sure the care we provide is safe. We convene hundreds of our clinical leaders every month to share our best practices and learn from each other. With over 1,000 healthcare sites across the U.S., we have a diverse spectrum of experts to draw from. The changes we make across our system can have a tremendous impact on how healthcare is provided in this country. 

We've found that open communication is essential for improving patient safety. For example, we're working to identify the near misses — or what we call "good catch" learnings — the situations when something might have gone wrong but didn't. When we capture the near misses and learn from harm events, we can change our processes accordingly. We strive to create and measure our open and supportive culture. 

Several years ago, we partnered with CMS and the Agency for Healthcare Research and Quality to pilot and adapt their CANDOR model to include a structure for supporting staff and improving communication with patients, families and their healthcare delivery team. We are now extending this program across our system.

More articles on patient safety and outcomes:

Nearly 50% of women get inappropriate antibiotic prescriptions for UTI, study finds
COVID-19 death risk 64% higher for UK variant, study suggests
10 top patient safety concerns for 2021, ranked by ECRI Institute

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