Bringing Everyone to the Table: Rapid Evidence Assessments Facilitate Meaningful Dialogue Across the Stakeholder Spectrum

In the last two decades, the number of commercially available genetic tests is thought to have increased by more than 5,000%—from approximately 1,500 to an estimated 100,000 or more. This number only increases daily as US-based, Clinical Laboratory Improvement Amendments (CLIA)-certified laboratories commercialize new tests through the laboratory-developed test (LDT) pathway. LDTs are specialized tests performed only by certain labs and are regulated by Medicare through CLIA. This pathway, which is largely exempt from FDA premarket review, permits tests to come to market quickly and with little regulatory oversight. 

The LDT pathway can be problematic because it does not require evidence from laboratories to support test claims. FDA previously identified problems with high-risk LDTs, ranging from a lack of appropriate controls yielding erroneous results to outright falsification of data. This makes it difficult for payers to know which tests to cover and for clinicians to know which tests are likely to help patients.  

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Topics: Evidence-based decision making

The Role of Primary Care Staff in Coordinating Care for Patients with Complex Medical Conditions

Posted by Laura Stone, Risk Management Analyst on Jul 11, 2023

According to the Centers for Disease Control and Prevention, 6 in 10 American adults have one chronic disease, such as heart, lung, or kidney disease; cancer; Alzheimer's disease; and diabetes, and 4 in 10 have two or more. These patients see more physicians across care settings, experience more transitions of care, and suffer more adverse events than those without chronic conditions.  

Care transitions and coordination can be a vulnerable time for patients, and many find themselves relying on patient navigators or advocates to help them manage their care.  

According to a 2020 survey published in the Journal of General Internal Medicine, nearly 40% of respondents reported at least one gap in care coordination and nearly 10% reported at least one preventable outcome such as repeat tests, medication interactions, and emergency department visits.​​  

In response to this concerning trend, ECRI addressed the consequences of poor care coordination for patients with complex medical conditions in its Top 10 Patient Safety Concerns for 2023. 

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Topics: Ambulatory Care

Managing Falls in Aging Services and Reducing Risk of Claims

Older adults who reside in senior living and skilled nursing communities fall more often than community-dwelling older adults; about half of all residents fall each year, and 10–25% of those falls result in fractures or concussions. Fall-related injuries come with significant medical costs; about $50 billion is spent each year on fall-related injuries and over $750 million is spent related to fatal falls. A recent survey of over 400 aging services executives and care providers found that, before any potential claims occur, falls cost each community an average of $380,000 annually. The average cost of a single resident fall is $4,743 in assisted living and $6,306 in skilled nursing, mostly driven by an increase in care level, additional administrative cost, and increased care staff cost. 

According to the CNA Aging Services Claim Report: 11th Edition, resident falls continue to be the most common cause for claims at 40.4% among the top allegations in aging services. The report also finds the average amount paid for fall-related claims in 2021 to be $227,199, a 15% increase from 2018. Death is the most common outcome associated with fall-related claims at 59.4% of the claim distribution, followed by fractures at 30.7%.  

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Topics: Aging Services

Cleansing, Normalization, and Integration – Keys to Optimizing CMMS Value

Discover the challenges associated with legacy equipment asset information and why so many healthcare technology management groups are seeking ECRI’s help with standardization and normalization of CMMS data.

Over the years, healthcare technology management teams have leveraged Computerized Maintenance Management Systems (CMMS) to enable more efficient work order management aimed at reducing asset downtime and improving maintenance workflows.  As workforce challenges have grown and technology has advanced, it is driving an even greater need for automation and operational efficiency.

Many hospitals have looked at upgrading and modernizing these systems and are struggling with how to consolidate, organize, and clean the data before migration.  Often, inconsistent equipment naming conventions and descriptions, and variable device classifications can impact predictive replacement planning, management of preventive maintenance procedures and work orders associated with cybersecurity threats, recalls, and field corrections that could impact the safety of patients and staff.  Maintaining a clean and organized CMMS can lead to greater operational efficiencies and improved patient outcomes, especially as health systems become more complex and continue to grow.

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Topics: Recall Management

Three Evidence-based Strategies for Preventing Pressure Injuries in Older Patients

Pressure injuries (PIs) can be a common health concern, especially for populations like older adults, where typical changes that accompany the aging process can already increase risks for these types of injuries. There are many potential causes and factors that contribute to the development of PIs. Examples include when a person's weight continually presses the skin against a surface such as a bed or mattress; or a therapeutic device like a splint creates constant pressure. Friction, shear, heat, and moisture also increase the likelihood of PI development for bedridden patients, particularly in long-term and subacute care facilities.  

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Topics: Aging Services

How to Improve Medication History and Reconciliation Processes in Ambulatory Care

Posted by Laura Stone, Risk Management Analyst on Jun 13, 2023

Patients often have multiple providers involved in their care. According to a 2019 study published in the Annals of Internal Medicine, 30% of older Americans can see at least five different doctors in a year.  

On the one hand, patients are able to receive specialty care to help manage multiple, complex medical conditions. On the other hand, such fragmentation in care may lead to medication errors from inaccurate or incomplete patient medication lists. In response to this concern, ECRI addressed inaccurate medication lists in its Top 10 Patient Safety Concerns for 2023. 

As stewards of their patients' care, it is essential that primary care providers take steps to review and reconcile each patient's medication list to avoid errors or adverse drug events, and organizational leaders must ensure that systems are in place to support these efforts.  

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Topics: Ambulatory Care

Supporting Women Veterans: The Role of Healthcare Leaders

On June 12, we recognize Women Veterans Recognition Day, a date designated to mark the anniversary of the signing of the 1948 Women's Armed Services Integration Act, which allowed women the right to permanently serve in the regular armed forces. The Act, along with President Truman’s decision to desegregate the military, also permitted African American women to officially serve in the military. The date is recognized nationally and by a number of states.
As a mission-driven organization, ECRI’s vision is a world where safe, high-quality healthcare is accessible to everyone, including our nation’s women veterans and service members. ECRI is proud to have women veterans as part of our workforce, working hard each day to advance our mission. Our nation’s women veterans face unique physical and mental health needs. Many bear the scars of combat, both those you can see and those you cannot. To effectively support their needs, healthcare leaders need to address gaps in the current systems that fail these veterans.

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Topics: Patient Safety

Evidence-based Strategies for Preventing CAUTIs from Indwelling Catheters

According to the Centers for Disease Control and Prevention (CDC), urinary tract infections (UTIs) are the most common healthcare-associated infection, and approximately 75% of UTIs acquired in the hospital are catheter-associated urinary tract infections (CAUTIs). 

Urinary catheters interfere with the natural host defense of clearing the bladder and urethral mucosa of microbes through voiding. The catheter also acts as a direct entry portal into the bladder for nearby microorganisms. Pathogens can access the urinary tract either from outside the catheter or from a contaminated collection bag or catheter-drainage tube connection. Many bacterial species colonize indwelling catheters as a thin, slimy film that adheres to a surface. In this form, bacteria are resistant to antibiotics and host defenses. 

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Topics: Patient Safety

Five Ways Predictive Replacement Planning Can Improve Your Bottom Line

Predictive Replacement Planning is a strategy that hospitals can use to reduce operational and capital costs and improve overall efficiency.
  1. Improved patient outcomes: Predictive replacement planning (PRP) can help facilities determine when medical equipment has reached the end of its lifespan, ensuring equipment failures do not negatively affect patient care.  
  2. Cost-savings: PRP can help hospitals avoid unplanned equipment replacements, reducing operational costs associated with emergency replacements.  
  3. Effective resource management: With PRP, hospitals can schedule equipment maintenance and replacements based on actual usage data, ensuring that resources are not wasted on over-maintenance. 
  4. Increased efficiency: With the ability to predict equipment failure, hospital staff can proactively arrange for equipment maintenance or replacement, freeing up time to focus on patient care. 
  5. Improved equipment standardization: PRP will help hospitals standardize equipment, thereby reducing operational costs by improving efficiencies and lowering costs due to savings in service contracts, clinician training, and parts inventories. Hospitals can also realize capital savings by grouping like purchases to a single vendor and reducing administrative efforts.
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Topics: Supply Chain

Navigating the Death of a Pediatric Patient

An ECRI member recently asked for information regarding support for healthcare providers navigating the death of a pediatric patient. In our response, we discuss strategies and provide relevant resources for healthcare staff confronted with the death of a child. 

Although patients and their families are obviously at the center of adverse patient safety events, a ripple effect often occurs, turning the involved healthcare providers into "second victims," who may require or benefit from organizational support. A survey of over 100 healthcare professionals regarding their grief after the death of a child found that the majority of second victims turned to others to talk about the child and their emotions (85%), used positive reframing (80%), sought emotional support (75%) or self-distraction (57%). Other strategies included seeking religious guidance (55%), meeting with the patient's parents (43%), and attending the patient's funeral (19%). More than half (53%) believed that turning to coworkers, friends, or family helped them the most to overcome their grief. The second most useful strategy was spending time alone (19%). However, 31% wished they had more emotional support from their colleagues, and while 8% received organized support from their workplace, 40% would have appreciated more "official" support. 

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Topics: Patient Safety

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