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:

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. 

​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. 

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.  

Sepsis is the body's overwhelming response to infection and can lead to tissue damage, organ failure, and death. According to the Centers for Disease Control and Prevention, anyone can get an infection, and any infection can lead to sepsis, including bacterial infections such as Staphylococcus aureus and Escherichia coli, as well as viral infections such as COVID-19 or influenza. 

According to the Sepsis Alliance, more than 1.7 million adult Americans develop sepsis each year, and approximately 30% of those diagnosed with severe sepsis do not survive. Among survivors, up to half develop postsepsis syndrome, leading to a shortened life expectancy, impaired cognitive function, and diminished quality of life. Yet it is estimated that 35% of adult Americans have never heard of sepsis. 

Regardless of the type of healthcare facility you manage—a hospital, an assisted living center, or an ambulatory care establishment—incident management for patient safety should be a primary focus of your organization. By taking time to assess patient safety, produce incident reports when accidents or infections occur, and understand the causes of various accidents, you can offer a better quality of care over time. That being said, it's important to know what you can gain by finding the proper incident reporting and management system for your organization. If you want to provide better healthcare for your patients and support risk managers, clinicians, and other healthcare professionals, consider the many benefits of an effective incident management system.

1. It allows you to identify trends in common medical errors

There are certain accidents that might only occur once, becoming an outlier in your organization's medical history; however, it's more common for specific types of incidents to occur repeatedly. An effective incident management system allows you to identify trends in common medical errors as your staff inputs incident reports. Whether you encounter medication safety issues, healthcare-associated infections, or even safety issues such as frequent falls among older adults, incident reporting and management can help you identify these trends so that you can take action.

Accidents, outbreaks, and other incidents regularly occur in healthcare settings. This is not surprising to most healthcare providers, including those working in aging services and ambulatory care facilities.

But acknowledging that incidents will happen can be the impetus behind taking precautions to prevent them. With effective incident management systems and protocols in place, your team can create a culture of safety and security that helps protects patient and staff health, as well as your institution’s reputation and financial stability.

But what does a good incident management system look like? How can you improve your system, and where can you get fact-based, reliable support that will help your team build a better incident prevention and management system?