Patient safety has suffered in COVID-19, and it must be addressed

So much for years of progress in improving patient safety.

After years of impressive gains, federal officials say the COVID-19 pandemic swiftly eroded gains in patient safety in healthcare systems. Leaders with the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention said there are troubling indicators of declines.

In an analysis published Feb. 12 in the New England Journal of Medicine, they outlined sharp increases in infections. “We have observed substantial deterioration on multiple patient-safety metrics since the beginning of the pandemic, despite decades of attention to complications of care,” the authors stated in the analysis.

They also called on healthcare leaders to put a much greater emphasis on improving safety for both patients and staff, and they said it needs to happen now.

“We cannot afford to wait until the pandemic ends,” they wrote.

The CMS and CDC leaders also said the federal government could be looking at new steps to improve patient safety as well.

The federal officials note the obvious contributing factors. Hospitals have faced unprecedented stress during the COVID-19 pandemic. Doctors, nurses and other caregivers are exhausted and many healthcare organizations are dealing with staff shortages.

But they also contend that for the erosion of patient safety to be so evident so quickly, it suggests the healthcare system isn’t as focused on safety as it should be.

“The fact that the pandemic degraded patient safety so quickly and severely suggests that our health care system lacks a sufficiently resilient safety culture and infrastructure,” the federal officials wrote.

The analysis looks at central-line–associated bloodstream infections in U.S. hospitals, which had fallen by 31% in the 5 years preceding the pandemic. That progress was almost instantly wiped out with the arrival of COVID-19. In the second quarter of 2020, central line infections rose by 28%, compared to the same quarter in 2019.

Hospitals also saw increases in catheter-associated urinary tract infections and ventilator-associated events, the report said.

Nursing homes endured difficulties as well.

In the second quarter of 2020, rates of falls causing major injury at skilled nursing facilities rose by 17.4%, while pressure ulcers increased by 41.8%, according to the analysis, which cited data submitted to CMS.

Patient safety practices, such as safety audits and error reporting, have lagged because clinicians have been overworked during the pandemic, the authors stated. Supply chain issues, including shortages of personal protective equipment, have posed more risks to healthcare workers.

The analysis cited data from 2020 but the authors noted the rise of the Delta and Omicron variants of COVID-19 make it unlikely patient safety metrics will return to pre-pandemic levels in the near future.

While much of the focus on the analysis is on the safety of patients, the CMS and CDC officials say healthcare organizations must do more to protect their workers, and that seems to be a growing area of concern in President Biden’s administration. Citing a 249% increase in injury and illness rates among workers, the U.S. Department of Labor recently urged healthcare organizations to develop and utilize safety and training programs.

The healthcare industry must take a hard look at ways to improve patient safety, the federal officials wrote.

It’s clear the solution can’t involve asking clinical staff to work harder, the federal officials acknowledge. Rather, the healthcare system must “provide them with more tools and an environment built on a strong foundation of wellness and on instilling and rewarding a culture of safety,” they wrote in the NEJM analysis.

The leaders outlined a number of steps to improve safety, including new measures at the federal level.

Learn from other industries

Healthcare organizations should follow the example of other industries, which have embedded safety training and practices throughout their organizations. Healthcare leaders must develop clear metrics to measure safety, they said.

‘System of safety’

Healthcare industries need to promote safety throughout the entire organization so it’s clear that it’s a top priority. The healthcare sector “has not instituted a thorough system of safety that reaches from the boardroom to the front lines and that can be maintained during times of crisis.”

More federal oversight

The officials suggested CMS could be expanding its oversight to drive improvements in patient safety. “CMS must also use our oversight functions to ensure that emergency-preparedness and quality-improvement programs are more than plans on a shelf. Such a culture would ensure that patients and staff are protected from harm while rendering the system more resilient, especially during a crisis,” they wrote.

More use of safety data

The CMS and CDC said it’s looking to expand the collection and use of data on safety indicators, including maternal health and mental health. Electronic medical records contain a host of data that could be included in patient safety measurements in the CMS Quality Payment Program.

New national goals

The authors called for “renewed national goals of harm elimination throughout the healthcare system.” They also said a core strategy is needed to address workforce shortages and promote “radical transparency.”

Going beyond the hospital

The healthcare sector must pay attention to safety metrics beyond the hospital, including outpatient care and diagnostic errors

Lee A. Fleisher, chief medical officer and director of The Center for Clinical Standards and Quality at CMS, was the lead author of the piece. Michelle Schreiber, the center’s deputy director, also contributed to the analysis, along with Denise Cardo, director of the Division of Healthcare Quality Promotion at the CDC, and Arjun Srinivasan, the division’s associate director.