ECRI Blog

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.  

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.

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. 

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.

​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. 

As described in ECRI’s white paper, Mismatched Needs and Services Can Lead to Harm: A Systems REThinking Approach, organizations should systematically evaluate the scope of services they offer to meet resident needs and determine their staffing, infrastructure, and technology needs to fulfill these obligations.  

In the modern healthcare environment, healthcare workers often experience job-related fatigue, which can have a negative effect on patient and staff safety and well-being. In addition, worker fatigue is associated with lost workdays, an increase in occupational injuries (e.g., needlesticks), liability issues, and increased turnover. 

Healthcare organizations must address the effects of fatigue on healthcare workers and, whenever possible, reduce duty hours to allow workers more recovery time. However, even the best schedules and optimal staffing cannot eliminate the circadian disruption associated with night work and long hours. Healthcare organizations should implement fatigue management strategies as part of their system-wide efforts to increase patient safety and reduce medical errors. A good fatigue management plan should address the following: 

• Education and training on the effects of fatigue 
• Strategies to increase alertness and mitigate fatigue 
• Opportunities to identify and treat any medical conditions that may affect alertness or fatigue, such as sleep disorders 
• Scheduling policies 
• Adverse event, medical error, and occupational injury investigations 

Healthcare organizations may also wish to consider developing a fatigue risk management system—data-driven sets of management practices for identifying and managing fatigue-related safety risks—as a subset of their overall safety management system. ​ 

Additional resources that may be helpful include the following: 

When compared to ten other developed nations, the United States has the highest maternal death rate. Yet, according to a recent maternal mortality review committee report by the Centers for Disease Control and Prevention, 84% of pregnancy-related deaths are preventable. This maternal health crisis has been shaped, in part, by socioeconomic inequities and inconsistent insurance coverage policies, which limit healthcare access by underserved populations. So what tools are available now to help reduce preventable harm among childbearing women? Clinical evidence suggests that telehealth could be one solution. 

A member recently asked about liabilities associated with the utilization of data from nonprescription consumer wearable devices that track various health statuses (e.g., heart rate, blood pressure, activity levels, glucose levels). In our response we discuss the potential risks of utilizing such data and provide information and resources to consider.

The wearable medical device market is rapidly expanding—Deloitte Global predicts that nearly 440 million consumer health and wellness wearable devices will ship worldwide by 2024, and around one-third of individuals own one. However, laws and regulations regarding their use remain unclear. While some physicians support their use as a way to encourage patients to track lifestyle habits that contribute to overall healthcare, others are concerned about associated risks. Many nonprescription commercial wearable devices available to the public are not approved or regulated by the U.S. Food and Drug Administration (FDA), and all have varying degrees of accuracy, usability, privacy protections, and interoperability with existing healthcare technology (e.g., electronic health records, remote patient monitoring systems prescribed by providers). Research on the predictive quality of wearables for health outcomes is also lacking. A 2018 JAMIA literature review found only eight studies of at least moderate quality that supported a significant association between data from wearables and the tracked outcome.