Here Are 3 Areas With the Biggest Threats to Patient Safety in Health Care Settings

The 2019 Annual Patient Safety & Quality Industry Outlook report examined this year’s top risks to patient safety and hospital bottom lines.
By: | July 12, 2019

The 2019 Annual Patient Safety & Quality Industry Outlook report from Riskonnect and Patient Safety & Quality Healthcare examines this year’s top risks to patient safety and hospital bottom lines.

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According to 228 respondents in a February 2019 survey of health care providers, the most worrisome areas of risk were slips, trips, and falls (64%); health care-associated infections (58%); medication mix-ups (54%); workplace violence (34%); and antibiotic stewardship (32%).

Employee issues were also a concern, including the impact of adverse events on the clinicians involved, or “second victims,” and burnout, with 56% of respondents reporting their organization was slightly or highly ineffective at helping staff handle burnout.

In the area of patient engagement, large portions of respondents cited patient safety (90%), patient satisfaction (79%) and clinical outcomes (57%) as areas in need of improvement. Surprisingly, many also said their organizations were strong in those same areas: patient safety (40%), clinical outcomes (38%) and patient satisfaction (23%).

Other areas of concern include patient financial engagement, which 52% of respondents said was somewhat weak or very weak, as well as family engagement in patient care (37%), patient engagement in care (34%) and delivering what the patient values (26%).

Many respondents saw progress in the area of suicide risk, with 38% assessing their hospital’s efforts as highly effective and 43% as slightly effective.

Here are three areas that pose some of the biggest threats to patient safety in the health care setting:

1) Patient Engagement

Regarding patient safety culture program goals, 47% thought communication openness was the area most in need of improvement, followed by hospital handoffs and transitions (39%) and feedback and communication about errors (38%).

The report emphasizes the importance of patient engagement in reducing diagnostic errors and cites research that identifies four areas where poor clinician-patient relations contribute to diagnostic errors: clinicians ignoring or disregarding patient or family-member reports of symptoms or changes in patient status; disrespect of patients; failure to communicate; and manipulation or deception.

Recommendations to reduce diagnostic errors include: lifelong communication training for clinicians; incorporating communication skills, professionalism, and safety knowledge in certification and continuing medical education programs; systematic collection of patient observations of clinician behaviors; developing interventions to address patient reports of risky clinician behaviors; and including patient reports of diagnostic errors in training and patient-safety programs.

2) Clinician Support

Progress in the area of support for clinicians has been slow. While the percentage of respondents reporting that their organization lacks any second victim support program is down to 55% from 62% in last year’s survey, that is still more than half.

There were slight increases in respondents reporting that their organizations have a program in place (18%, up from 16% last year) or were exploring such programs (18%, up from 13%).

“Second victim” support programs were regarded as highly effective in helping nurses (14%), physicians (12% highly effective), other clinical staff (11%), care managers (11%), nonclinical staff (9%) and executive staff (9%).

Burnout is another major concern. A 2018 meta-analysis of 47 studies involving more than 40,000 physicians calls physician burnout an “epidemic” that is “associated with a higher risk of patient safety incidents, poor care, and lower patient satisfaction.”

Burnout was most common among critical care physicians (48%), neurologists (48%), and family physicians (47%), with women more likely to experience burnout than men (48% versus 38%), and those aged 45–54 range most likely to experience it (50%).

Burnout accompanied by symptoms of depression and emotional distress was associated with a twofold increase in risk of safety incidents. Respondents identifying as depressed reported being less friendly with patients (29%), less motivated to be careful when taking patient notes (24%), more likely to express frustration in front of patients (14%) and prone to errors they wouldn’t otherwise make (14%).

While 39% of respondents described their organization’s efforts to address staff burnout as slightly effective, only 5% called them highly effective, and a majority described them as slightly ineffective (36%) or highly ineffective (20%).

3) Hospital-Acquired Infections

Half of survey respondents reported their facilities were very strong in infectious disease surveillance and reporting, with slightly fewer reporting very strong health care-associated infection prevention (48%), sterilization and disinfection (41%), isolation (39%), and hand hygiene compliance (35%).

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One of five respondents said their organization was somewhat weak or very weak in hand hygiene compliance, employee education and health, and isolation.

The report cites recent research suggesting that proper infection control practices could reduce hospital infections by more than half. Among the most preventable are bloodstream infections, a common and serious hospital infection that can cost $10,000–$20,000 to treat, and up to $40,000 if intensive care is necessary.

Respondents see progress in addressing suicide risk in hospitals, with a large majority reporting their organization is either highly effective (38%) or slightly effective (43%).

Looking Ahead

When asked their investment priorities in patient safety and quality innovation, 77% cited cyber security protection, followed by clinical communication platforms (70%), clinical test results notification systems (60%), automated clinical safety surveillance systems (59%), emergency notification systems (59%), and hand hygiene monitoring (58%).

Respondents see progress in risk management, with 45% reporting root cause analysis that was highly effective and 41% reporting slightly effective.

Risk assessments were seen as highly effective by 33% and slightly effective by 52%. Other risk management practices considered include hazard vulnerability analysis (30% highly effective/50% slightly effective), failure modes and effects analysis (27%/46%), patient tracers (31%/41%), system tracers (25%/47%), and enterprise risk management (21%/51%). &

Jon McGoran is a magazine editor based outside of Philadelphia. He can be reached at [email protected]

Risk Matrix: Presented by Liberty Mutual Insurance

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The R&I Editorial Team can be reached at [email protected]