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The Economic Cycle Research Institute (ECRI) has released its list of top 10 patient safety concerns for 2021 – and eight of them are related to or have been exacerbated by the ongoing COVID-19 pandemic.

Racial and ethnic disparities in healthcare tops ECRI’s list of patient safety challenges facing healthcare organizations this year.

Those in the Hispanic and Latinx population have been disproportionately affected by COVID-19. They are three times more likely to be hospitalized and are twice as likely to die from COVID-19 as White non-Hispanic people, ECRI notes.

Public Health Crisis

But racial and ethnic disparities in healthcare go beyond the pandemic. Maternal mortality is 3.3 times as high among Black mothers as among White mothers, and Black adults are more likely to suffer and die from a stroke than are White adults, the organization says.

Overall, racial and ethnic minorities tend to receive lower-quality care and experience greater morbidity and mortality than nonminorities.

“Clearly, danger lipitor racial disparities will not disappear overnight. By profiling this issue, we are calling much-needed attention to this public health crisis,” ECRI President and CEO Marcus Schabacker, MD, PhD, said in a news release.

Taking the second spot on this year’s list of top patient safety concerns is emergency preparedness and response in aging services.

As of February 1, more than 570,626 COVID-19 cases have been confirmed among nursing home residents in the United States, and more than 112,383 deaths have occurred among those patients, according to ECRI.

“Emergencies often disrupt routine resident care and facility operations in long-term care. Aging services organizations should take an integrated systems approach to implement emergency response plans that concern all stakeholders: residents, workforce, and visitors,” ECRI advises.

Number 3 on the list is pandemic preparedness across the health system.

“Over the years, government investigations, congressional reports, and pandemic preparedness reviews have warned that America’s healthcare system was woefully unprepared for a fast-moving infectious disease outbreak. COVID-19 has proved these warnings to be true,” the organization says.

Number 4 on the list is supply chain interruptions.

The COVID-19 pandemic has “severely” strained healthcare supply chains, creating global shortages of key medical equipment and supplies, including ventilators, testing equipment, and personal protective equipment, such as masks, gloves, and gowns, ECRI notes.

To address these shortages, healthcare organizations have turned to nontraditional methods, such as off-label use of existing devices and use of non–medical grade equipment. Organizations have also had to use alternate manufacturers and supplies that are often “insufficiently vetted.”

In some cases, products ordered from these alternate sources were past their expiration date, damaged, below standard, or different from what was ordered. In some cases, they did not arrive at all. ECRI testing found that 60% to 70% of imported non-NIOSH-certified respirators failed to achieve 95% filtration efficiency.

ECRI testing also showed that 52% of gowns with unstated levels of protection failed to meet even the lowest protection standards, as reported previously by Medscape Medical News.

Number 5 on the list is drug shortages.

During the COVID-19 pandemic, supply chain disruptions and the huge number of critically ill patients led to shortages in nearly every drug class used for mechanical ventilation.

Other crises have also led to drug supply shortages; for example, in September 2017, a shortage of IV saline bags occurred after Hurricane Maria damaged a key saline manufacturing plant in Puerto Rico.

Drug shortages can result in changes, delays, or cancellations of medical procedures; limited treatment options; missed or delayed therapies; increased costs; increased stress on healthcare workers; and compromised patient safety.

The Final Five

Rounding out the top 10 patient safety concerns that ECRI says warrant the greatest attention in the coming year are the following:

6. Telehealth workflow challenges, which have accelerated because of the COVID-19 pandemic. Common problems include poor wifi, inappropriate monitoring, inadequate language services, and problems regarding health privacy.

7. Improvised use of medical devices, which, however well intended, may lead to serious problems regarding safety and regulatory compliance.

8. Methotrexate therapy. The weekly administration of this cancer drug, which is also used in the treatment of autoimmune diseases, leads to errors in dosing and dosing frequency.

9. Peripheral vascular harm. Use of peripheral intravenous catheters can lead to severe cases of injury and infection, extended lengths of stay, antibiotic treatments, and death.

10. Infection risk from aerosol-generating procedures. The exposure risk from performing aerosol-generating procedures on patients suspected of having COVID-19 is “very high.”

ECRI creates the annual list of top 10 patient safety concerns to help healthcare organizations proactively identify and respond to threats to patient safety. For each item on the list, the report offers recommendations from ECRI experts, as well as links to additional in-depth guidance.

This year’s ECRI report on top patient safety concerns for 2021 is being released in conjunction with Patient Safety Awareness Week, March 14 to 20. The full report is available online.

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