ECRI’s Top Patient Safety Concerns

By March 27, 2018 Commentary

The ECRI Institute helps health care organizations evaluate medical products and improve patient care.  Every year it issues a list of its top current safety concerns, which it intends to be a guide for products and processes that providers and policymakers can focus on.   (ECRI Brief)    At the top of this year’s list is diagnostic errors, followed by opioid safety across the care continuum, internal care coordination, workarounds, incorporating health IT into patient safety programs, management of behavioral health in acute care facilities, all hazards emergency preparedness, medical device cleaning and disinfection, patient engagement and health literacy and leadership engagement in patient safety.  Many of these are so vague or broad that I don’t know how they provide any guidance to anyone.  And having ten things to focus on for patient safety ensures that none will get any real focus.  ECRI, whose work I admire, claims the list is drawn from real adverse event reporting, but how do you report that lack of leadership engagement or of patient health literacy caused an actual patient safety issue.

Diagnostic errors is a more specific concern, but do they mean inaccurate test results, wrongful application of the test results by a clinician or what?  In some cases, diagnostic errors are understandable, there are not always clear delineations between the symptoms or test results for one disease versus another.  We all know opioid abuse is a problem and work is underway on finding alternatives for pain control.  Issues about care coordination have been around forever, can we be clearer on the exact processes that need to be improved?  Workarounds exist in part because existing IT systems in particular are not very useful, for example people ignore clinical alerts all the time, and it is often a good thing they do.  A workaround is an indicator of a flawed process many times, so I don’t know why they are highlighted as a safety concern.  Until health IT becomes more useful, I don’t know why incorporating more of it would improve patient safety.  A mentally ill patient is a danger to themselves and others, but we have forced providers, including ERs, to deal with people who have chronic mental illness and should be institutionalized, which the Supreme Court and many state legislators, in their sublimely ignorant wisdom have largely forbidden.  And so on.  I just found this year’s list to be particularly unhelpful and trite.

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