The da Vinci Surgical Robot and the Importance of Iterative Evidence Review

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 patientssometimes 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 

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Topics: Ambulatory Care

Video Recordings of Surgical Procedures: How to Ensure Consent, Privacy, and Confidentiality

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. 

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Topics: Patient Safety

Medical Errors and Health IT: What Does the Data Say?

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.

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Topics: Patient Safety

Non-medical Discharge: Navigating Legal, Regulatory, and Ethical Considerations

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. 

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Topics: Patient Safety

Preventing Short-Stay Readmissions

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. 

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Topics: Aging and Ambulatory Care

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

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