COVID-19 exposed many of the strengths and vulnerabilities of the American health care system – especially when it comes to hospital services. While hospitals were instrumental in saving countless lives during the pandemic, past improvements in some underlying measures of patient safety were challenged as caregivers and hospitals dealt with providing care in an unprecedented and unpredictable pandemic.
We continue to learn from this experience and hospitals are continuing the push to be better.
That’s what makes today’s announcement by HHS Secretary Xavier Becerra about the creation of the National Healthcare System Action Alliance to Advance Patient Safety vitally important. This group will build on 20+ year partnership between health and hospital systems, patients and families, as well as federal partners, like HHS, CMS and the Agency for Healthcare Research and Quality’s (AHRQ).
It all starts on the frontlines – where we learned a lot about the resilience of our hospitals and caregivers. Despite the tragedy and loss associated with the pandemic, those providing care quickly adapted to find creative and effective ways to save lives and keep patients safe during very perilous times.
Rachel Watson’s story is a real-world example of this resilience. She was diagnosed with COVID-19 in 2021 and ended up spending 89 days in two different Florida hospitals. Rachel was so ill that her heart stopped five different times, but the staff at both facilities met each challenge using coordinated care and the most appropriate level of treatment to keep her alive. She is now back home with her family and has resumed a normal life.
Rachel is just one of countless COVID-19 success stories. Her care required life-saving services and daily, ongoing processes, not just to treat her long COVID-19 symptoms, but to ensure she was safe and that no unintended accidents or harms occurred.
In the midst of COVID-19 hospitals, doctors, nurses, and other professionals in the health care field work diligently as they always do to create processes and procedures, through the use of technologies and medical sciences to overcome and find the best care for the patients.
We must recognize however, that the challenges of COVID-19 tested caregivers and hospitals. Diagnosis and treatment of COVID-19, particularly in the many surges, greatly stressed providers and the regimens for care that have been so carefully developed. The impact on staff and hospitals resulted in difficulties in maintaining carefully honed safety practices.
It is important to note developments in safety prior to COVID-19. The health care landscape has been continually changing with health and hospital systems operating in increasingly complex and evolving environments. Every point in the care-giving process contains a certain degree of inherent unsafety. A team-based approach with clear policies, strong organizational leadership and governance, real-time data to drive safety improvements, skilled health care professionals and effective involvement of patients and families in the care process, are all needed to ensure sustainable and significant improvements in the safety of health care delivery.
Due to a systemic approach to addressing hospital harms, the risk of patients encountering medical errors and hospital acquired infections has improved over the past decade. According to a JAMA article published in July 2022, the rates of adverse events in hospitalized patients significantly declined for patients with acute myocardial infarction, heart failure, pneumonia, and major surgical procedures between 2010 and 2019 and significantly declined for patients with all other conditions between 2012 and 2019.[1] Additionally, data released by the Agency for Healthcare Research and Quality (AHRQ) showed national efforts to reduce hospital-acquired conditions (HACs), such as adverse drug events and injuries from falls, saw an overall rate reduction of 13 percent from 2014 to 2017.[2]
Accountability through the Centers for Medicare & Medicaid Services (CMS) HAC Reduction program has resulted in significant progress in improving patient safety overall due to oversight, payment adjustments and the public reporting of results. And while the program isn’t perfect, CMS and AHRQ data have shown improvements in patient safety in hospitals. The focus on HAC reduction has driven improvement efforts in other areas as well, including detection and surveillance of adverse events, as a culture of quality improvement and safety becomes more and more imbedded in the work of nurses, physicians, and other caregivers.[3]
Despite these steady improvements in patient safety, COVID-19 showed us that our health care system and processes can be fragile. The pandemic had such an effect on health care delivery and safety outcomes that many hospitals witnessed some vulnerabilities, and our medical systems were less resilient to external factors than we thought. Many hospitals found addressing patient harm and promoting patient safety challenging, in light of the ongoing pandemic and its effects on hospital operations.
There was also variability in how states and locales responded to COVID-19, and the data reflect differences in which patients, those with and without COVID-19, experienced hospital harms. More research is needed to fully understand the impact of COVID-19 on patients.
Adequate staffing has been a consistent issue for health systems over the years, but the pandemic exacerbated those workforce challenges to a crisis level. Provider burn out and supply chain problems add to the stress hospitals face continually, but it doesn’t change their mission of providing quality care to the patients that depend on them.
Not every adverse or temporary harm event is preventable. As the Office of the Inspector General (OIG) noted in its May 2022 report, 56 percent of harm events studied were not preventable and occurred even though providers followed proper preparation and procedures. Additionally, they noted that events were determined not preventable for several reasons, including that the older patients were found to be highly susceptible to the event due to poor health status.3
Next Frontier – Steps Forward
The next era in patient safety will require new approaches to defining preventable hospital harms so that solutions can be fit-for-purpose.
The introduction of data collection efforts that don’t impede care processes and workflow is essential to encourage the bidirectional exchange of information. Administrative data is inadequate and new technologies, such as automated systems and artificial intelligence- (AI) generated algorithms, present untested opportunities.
The best path forward is to work to build on the national patient safety efforts through existing structures, such as CMS and AHRQ. Additionally, quick and sustainable answers are needed to address ongoing workforce challenges.
The highest priority for hospitals is to make sure patients are safe. Our systems are working hard every day to define the root cause of problems and focus on targeted solutions that address today’s patient safety challenges.
[1] Eldridge N, Wang Y, Metersky M, et al. Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019. JAMA. 2022;328(2):173–183. doi:10.1001/jama.2022.9600
[2] AHRQ, AHRQ National Scorecard on Hospital-Acquired Conditions Final Results for 2014 Through 2017, https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/Updated-hacreportFInal2017data.pdf
[3]OIG, Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018. OEI-06-18-00400, May 2022.
