ECRI Blog

​​​​Policies for managing comorbidities, as well as multimorbidity and multiple chronic conditions, vary based on the medical conditions involved; therefore, developing a uniform policy is not necessarily feasible given the differences between conditions. Approaches to comorbidity management often overlap with typical care management strategies. However, the presence of comorbidities often requires treatment adjustments based on disease-specific considerations, making individualized treatment plans the most appropriate approach. Professional organizations have developed guiding pri​​​nciples that healthcare organizations can use to tailor comorbidity management best practices. For example, see the following guiding principles for managing comorbidities developed by a working group convened by the American Geriatrics Society:

September 18 -22, 2023, marks Falls Prevention Awareness Week in the United States. Despite widespread fall prevention programs, fall incidence rates are on the rise in the United States, with an average 1.5% annual growth rate from 2016 to 2019. Although information specific to assisted living (AL) is difficult to track given the varying degrees of reporting and oversight, an overview of claims data provides a snapshot of the current state of fall-related claims in AL. According to the 2022 CNA Aging Services Claim Report:

Patient elopement is when individuals leave an area they are expected to stay within, for their safety. Elopement from a healthcare facility can have devastating consequences for a patient, including serious injury or death. 

Oftentimes, resources on elopement are specific to the aging services setting since most elopements occur among older adults who have been diagnosed with Alzheimer's disease or dementia; however, elopement can present a risk for all manner of patients, particularly behavioral health patients and patients with altered mental status. 

In recent years, more OB units in rural areas have experienced closures and maternity care deserts have grown. In response, many rural healthcare organizations are exploring creative approaches in their efforts to maintain OB and gynecology (OB/GYN) services for their patients. The National Rural Health Association describes some of the approaches hospitals and policy makers have taken to try to maintain OB services, such as addressing costs of maternity care, increasing staffing levels, and consolidating health systems.

Combining units and going "on diversion" may also be considered creative approaches to addressing staffing issues in OB units, but such efforts raise potential risks.

​​​​Healthcare providers continue to face widespread economic challenges that directly affect the supply chain—from record inflation and dwindling margins, to shortages of supplies and workers, to cost increases in labor and supplies. In a survey conducted by Kaufman, Hall and Associates, 71% of health systems reported distribution delays; 58% surveyed reported raw product and sourcing availability disruptions.¹   

ECRI included supply chain disruptions in its annual Top 10 Patient Safety Concerns in 2021 and 2022. While supply chain challenges are anticipated to remain, nonacute care facility leaders can implement proactive strategies to achieve supply chain resilience and avoid disrupting or delaying necessary patient care. 

Medical technology is constantly evolving.As new medical devices are developed and existing devices are updated, clinical trials areconducted to confirm the technology is safe and provides the intended benefits to patients—sometimes over several yearstoreflect the technology’s long-term effects. As additionalclinical trials progress and their results are published, theevidence surrounding a medical device’s safety and effectiveness can change overtime, requiring health technology assessment organizations,such as ECRI, to revise their conclusions on the device.  

Many organizations record surgical procedures performed at their facilities with the intention of using the footage for educational or quality assurance purposes, among other reasons. However, it is important to ensure that such recordings and photographs adhere to the organization's policies regarding patient consent, privacy, and confidentiality, as well as medical record documentation and storage. Because the circumstances may vary, risk managers should carefully consider whether requirements for obtaining a patient's authorization for the use and disclosure of protected health information (PHI) are being met. 

Health information technology (IT) is a powerful tool for documenting and sharing information about patients’ health and helping providers to make well-informed decisions about patient care. However, problems relating to health IT, including both system and user issues, are also sometimes cited as factors in causing or contributing to patient harm—and even lawsuits.

Patient Safety

Problems related to health IT can cause patient harm, including serious harm or death. A 2017 systematic review of health IT problems and their effect on patient outcomes and care delivery found that health IT problems were associated with patient harm and death in 53% of the studies reviewed. Use errors and poor user interfaces impeded the receipt of information and led to errors of commission in decision-making. Problems with system functionality (including poor user interfaces and fragmented displays), system access, system configuration, and software updates caused delays in care delivery. Several studies characterized medication errors related to health IT problems in more detail.

Hospitals may wish to discharge patients for a variety of non-medical reasons (e.g., if the patient is being violent towards staff, patients, or visitors; if the patient is exhibiting racist behavior). However, administrative discharge of patients for non-medical reasons is a more complicated legal and regulatory issue for hospitals than it is for physician practices who wish to terminate a relationship with a patient. 

​Every care transition carries increased risk of adverse events, poor health outcomes, emotional instability, and high healthcare costs—and the risks are even more elevated for older adults, especially for those with multiple chronic conditions. 

Although research has mainly focused on transitions from hospital to home or skilled-nursing facility (SNF), a few studies have highlighted the need for increased attention on short-stay patients. A Department of Health and Human Services' Office of Inspector General report found that 22% of Medicare beneficiaries who had spent 35 days or less in a SNF for rehabilitation after hospital discharge experienced an adverse event. Fifty-nine percent of the adverse events were deemed preventable by physician reviewers and 79% resulted in prolonged SNF stay, transfer to a different SNF or postacute facility, or hospitalization. Problems related to medication and patient care accounted for most of these adverse events, followed by infection-related events. (OIG) Another study found that fewer than 53% of short-stay patients at SNFs have a successful—meaning no hospitalizations or deaths within 31 days—discharge home or to community-based services (Guzik and Kothari). 

​​​Reducing hospital readmissions has long been an area of focus as they are associated with a quadrupled mortality rate within 100 days (Burke et al "Hospital"). Although national initiatives such as the SNF Value-Based Purchasing program aim to incentivize facilities in improving postacute and transitional care services, monetary penalties or incentives only go so far without providing SNFs the tools and resources needed to make such improvements. In fact, the program did not offer a viable path for nearly all (99.3%) low-performing SNFs to avoid financial penalties through improved readmission rates (Burke et al. "Skilled"). These results suggest that postacute care providers need actionable improvement guidance that hinges on current best practices.