Patient safety while receiving health care is an obvious concern. Some dangers are also obvious, like falling in a hospital or being exposed to dangerous germs. Other dangers are more subtle. In the 2017 version of an annual report the ECRI Institute gives its top ten list of patient safety issues. (ECRI Report) The list was created from surveys, expert consultation and safety data sources. In order the top ten are information management in EHRS, unrecognized patient deterioration, implementation and use of clinical decision support tools, test resulting reporting and followup, antimicrobial stewardship, patient identification, opioid administration and monitoring in acute care settings, behavioral health issues in non-behavioral health settings (i.e., that crazy person who shoots a doctor in the ER), management of new oral anticoagulant drugs and inadequate organizational processes and systems to improve safety and quality.
So, a few observations. Note that two of the top three relate to health information technology, and deservedly so. Electronic medical records don’t help doctors and other clinicians identify the truly relevant information to help manage a patient’s health and health care. They interfere with real patient interactions and take too much clinician time. Clinical decision support often misses important information and gives alerts on unimportant issues, leading to alert fatigue. Many other items on the list also implicate IT, like test result reporting. Information technology in health care clearly has a long road ahead to be user-friendly and a truly valuable aide to better care delivery. And how can patient identification still be such a problem? How are we still cutting the wrong leg off of patients or taking out the wrong kidney? We can’t find a single patient identifier that everyone uses? How long are we going to talk about overuse of anti-infective medications and opioids? The report doesn’t give a lot of suggestions for improvement, but does have links to other materials to help address these concerns. The biggest underlying problem is the overwhelmed state of most of our clinicians; they are besieged by regulatory and payer demands, so their ability to attend to patient’s needs, much less systemic issues, is severely taxed. Patient safety will remain jeopardized until that is fixed.