ECRI Blog

The EtO Sterilization Dilemma

Ethylene oxide (EtO) sterilization has been in the news a lot lately, and healthcare has much at stake. According to officials at the U.S. Food and Drug Administration (FDA), approximately 56% of all critical medical devices are sterilized using industrial EtO sterilization. Currently, there are no validated industrial alternatives, so additional closures of EtO processing facilities would have the potential to impair the U.S. healthcare system.

While some state legislators are considering bans on industrial EtO sterilization facilities, healthcare leaders, manufacturers, and FDA have been reviewing options to ensure the availability of sterile medical devices and supplies necessary for patient care.

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Topics: Health Devices, Patient Safety, Supply Chain

Diagnosing Communication Gaps in Diagnostic Test Reporting

In the United States, there are 30 times more outpatient visits as hospital discharges. As a result of the high volumes and complexities inherent to ambulatory settings, one in twenty patients can expect to experience a diagnostic error in their lifetime. According to the Agency for Healthcare Research and Quality, 55 percent of patients said that diagnostic errors were a chief concern to them. 

Earlier this fall, ECRI Institute Patient Safety Organization took an in-depth look at patient safety events in ambulatory care, specifically physician practices and healthcare clinics. Nearly half of the 4,355 analyzed events were related to diagnostic testing. Errors that occur during diagnostic testing can have potentially devastating consequences for patients. The majority of these events occurred after tests had taken place, often due to a gap in communication.

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Topics: Patient Safety, Aging/Continuum of Care

Outsmarting an Impossible Medical Equipment Budget

When Washington Adventist Hospital of Maryland hired ECRI Institute to provide equipment planning services for their new 170-bed hospital, they were in a financial bind. Their Certificate of Need (CON) budget for patient care equipment was only $33 million. But, after we completed detailed user group meetings, it was clear that the actual cost for medical equipment would be closer to $65 million.

Our client was not alone in getting caught in the CON budget squeeze. Currently, 35 U.S. states maintain some form of CON program—including all states east of the Mississippi, except Pennsylvania and New Hampshire. CON programs give the state government the power to determine whether there is a need for a new hospital or nursing home before it is approved for construction.

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Topics: Industry Trends, Technology Trends, Equipment Planning

Safer Opioid Prescribing through Health IT

Editorial Note: This blog was also co-authored by Shari Medina, MD, of Harris Healthcare, chair of EHRA’s Patient Safety Work Group who led the Partnership for Health IT Patient Safety’s workgroup on this joint project; and Mark Segal, PhD, FHIMSS, principal, Digital Health Policy Advisors.

The United States is in the midst of an opioid use epidemic. Patients, providers, pharmacists, pharmaceutical companies, and electronic health record (EHR) developers have each been highlighted for their role in responding to the crisis. This blog focuses on the role of health IT in particular, and the safe practices that can be put in place for opioid prescribing.

As conveners of the Partnership for Health IT Patient Safety, a multi-stakeholder collaborative, ECRI Institute sees a very important role for developers of EHRs and other health IT in promoting opioid-related patient safety. Employing health information technology (IT) for early identification of at-risk patients and for safer prescribing can promote more efficient deployment of preventive resources and help reduce the risk of persistent opioid use or abuse.

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Topics: Patient Safety

Spread Best Practices, Not Infection: Our Commitment to CDC’s Challenge on Anti-Microbial Resistance

Anti-microbial resistance (AMR) presents serious global concerns, now and in the future. The World Health Organization (WHO) lists AMR as a top ten threat to public health. Last year, there were 700,000 deaths worldwide from AMR. That number is expected rise to 10 million a year in 2050—more lethal than cancer—if we fail to change what we are doing today.

Google the term “superbug” and you’ll see close to 4,000,000 hits. The rise of superbugs—microbes resistant to powerful drugs—led the Centers for Disease Control (CDC) to create the AMR Challenge, a year-long effort to accelerate the fight against antimicrobial resistance across the globe. CDC mobilized commitments from more than 270 countries and organizations around the world, including my organization, ECRI Institute. Action-based commitments are key. Without action, many nations risk slipping back into the pre-antibiotic era, compromising the success of major surgery, cancer chemotherapy, and other health care—and serious economic impacts, too. 

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Topics: Patient Safety, Technology Trends

ECRI Data Help Reignite Support for Patient Identifier in Congress

After heart disease and cancer, medical errors are the third leading cause of death in the United States and include misdiagnoses, incorrect anesthesia, delayed treatment, and patient misidentification.

Patient identification has been on the minds of healthcare leaders and policy makers for more than two decades. When the Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996, it called for developing a national patient identifier that would solve patient misidentification by assigning a unique, permanent number to every individual in the United States. The idea was to implement a uniform approach for accessing a patient’s medical history across the healthcare system. After HIPAA became law, Congress blocked this effort over privacy concerns, and the issue gradually faded from public attention.

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Topics: Industry Trends, Patient Safety

Reining in Unbridled Uses of Robotic-Assisted Surgery

A 2019 JAMA viewpoint article, Is It Time for Safeguards in the Adoption of Robotic Surgery?, explores the risks associated with the increasing, uncontrolled, and indiscriminate use of robotic-assisted surgery. We could not agree more.

For more than two decades, ECRI Institute has been emphasizing these risks based on our evidence assessments and patient safety work. We do not dispute the many potential benefits of minimally invasive robotic surgery procedures. However, we are solidly grounded in the “show me the evidence” camp. Our concerns fall squarely in three areas: patient safety and surgeon experience, evidence, and cost.

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Topics: Industry Trends, Technology Trends

Three Costly Pitfalls of Purchased Services Contracts

Purchased services are seen as the next great savings frontier in healthcare—and with good reason. Spend on purchased services accounts for approximately 30 to 35 percent of a hospital’s non-labor expenditures. Tapping into even a small portion of that spend can lead to significant financial savings. However, purchased services contracts are complex and the legal language can be difficult to understand. What seems like a competitively low price may actually result in unexpected charges and poor performance outcomes.

Over the past few years, I’ve worked with many hospitals and health systems on purchased services contracts and have seen my share of “the good, the bad, and the ugly.” What are some of the recurring themes? Some vendors bury language that is advantageous to their business. They omit key information and make performance management difficult for the hospital. While every purchased services contract is unique and every circumstance is different, it is possible to mitigate common traps and omissions that can lead to unexpected costs, poor performance, and no remedy when things go south.

Looking for service contract pitfalls to avoid? Check out my top three purchased services contract problem areas to gain the insight you need to improve the quality of services and drive savings across your organization.

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Topics: Supply Chain

4 Ways to Prevent Harm from Surgical Staplers

If you’ve been following medical device safety issues this year, there’s a good chance you’ve seen the headlines about patient injuries and deaths related to internal surgical staplers. The devices are commonly used in many high-risk surgical procedures. Misuse and malfunction of surgical staplers can lead to serious complications—as we’ve seen during our own research and accident investigations.

The stapler cases we investigate tend to be associated with serious injuries or fatalities, some of which could have been prevented. The overall adverse event rate is low relative to the number of times staplers are used; however, cases of preventable death are chilling. This has led ECRI Institute to thoroughly research and evaluate staplers and to publish safety hazards to our members. In fact, surgical staplers have appeared twice on our annual list of Top 10 Health Technology Hazards— first in 2010 and again in 2017.

So, why is this decades-old technology in the news now? And, more importantly, what can you do to keep patients safe?

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Topics: Health Devices, Patient Safety, Accident Investigation

Avoiding the Blame Game in Preventing Medical Errors

In late 2017, a catastrophic medication error led to a patient death at Vanderbilt University Medical Center. While waiting for a PET scan, an elderly woman was incorrectly administered vecuronium, a paralyzing neuromuscular blocker, rather than the prescribed sedative Versed. It was reported that, because vecuronium suppresses normal respiration and the patient was left unattended while waiting for the test, she suffered cardiopulmonary arrest. Although she was resuscitated, it was too late to prevent brain death, and she was later removed from life support.

This case was widely reported in the media as an example of preventable medical errors that injure or kill too many patients, despite our efforts to make healthcare safer. As we reach the 20-year anniversary of To Err Is Human, the landmark Institute of Medicine report that crystalized the patient safety movement in the U.S., we must humble ourselves with the knowledge that while we’ve made many improvements, there is still much more work to do.

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Topics: Patient Safety

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Our evidence supports the advancement of care around the world. Read our articles, get industry updates and trends, and learn a little more about us on the ECRI Institute blog.

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