Fighting a common enemy: a catalyst to close intractable safety gaps

[Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]

BACKGROUND AND AIM

To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS).

MATERIALS AND METHODS

Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods.

RESULTS

36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods.

CONCLUSIONS

During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.

Recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic: a scoping review

OBJECTIVE

To map the recommendations for hospitalised patient safety in the context of the COVID-19 pandemic.

DESIGN

Scoping review using the method recommended by the Joanna Briggs Institute.

DATA SOURCES

Databases: Medline, SCOPUS, EMBASE, ScienceDirect, LILACS, CINAHL and IBECS; grey literature platform: Google Scholar; and 11 official websites of leading healthcare institutions were searched on 27 April 2021 and updated on 11 April 2022.

ELIGIBILITY CRITERIA

We included documents that present recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic, published in any language, from 2020 onwards.

DATA EXTRACTION AND SYNTHESIS

Data extraction was performed in pairs with consensus rounds. A descriptive analysis was carried out to present the main characteristics of the articles. Qualitative data from the extraction of recommendations were analysed through content analysis.

RESULTS

One hundred and twenty-five documents were included. Most papers were identified as expert consensus (n=56, 44.8%). Forty-six recommendations were identified for the safety of hospitalised patients: 17 relating to the reorganisation of health services related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment; 11 on the approach to the airways and the prevention of the spread of aerosols; 11 related to sanitary and hygiene issues; 4 about proper use of personal protective equipment and 3 for effective communication.

CONCLUSIONS

The recommendations mapped in this scoping review present the best practices produced so far and serve as a basis for planning and implementing good practices to ensure safe hospital care, during and after COVID-19. The engagement of everyone involved in the care of hospitalised patients is essential to consolidate the mapped recommendations and provide dignified, safe and quality care.

Perspectives on Telehealth for older adults during the COVID-19 pandemic using the quadruple aim: interviews with 48 physicians

BACKGROUND

Telehealth delivery expanded quickly during the COVID-19 pandemic after the reduction of payment and regulatory barriers, but older adults are the least likely to benefit from this expansion. Little is known about physician experiences initiating telehealth and factors that fostered or discouraged adoption during the COVID-19 pandemic with older adult patients. Therefore, our objective was to understand experiences of frontline physicians caring for older adults via telehealth during the COVID-19 pandemic.

METHODS

We conducted semi-structured interviews from September 2020 to November 2020 with 48 physicians. We recruited a diverse sample of geriatricians (n = 18), primary care (n = 15), and emergency (n = 15) physicians from all United Stated (US) regions, rural-urban settings, and academic-community practices who cared for older adult patients during the pandemic using purposive sampling methods. We completed framework analysis of the transcribed interviews to identify emerging themes and used the Quadruple Aim to organize themes.

RESULTS

Frontline physicians described telehealth as a more flexible, value-based, and patient-centered mode of health care delivery. Benefits of using telehealth to treat older adults included reducing deferred care and increasing timely care, improving efficiency for physicians, enhancing communication with caregivers and patients, reducing patient travel burdens, and facilitating health outreach and education. Challenges included unequal access for rural, older, or cognitively impaired patients. Physicians noted that payment parity with in-person visits, between video and telephone visits, and relaxation of restrictive regulations would enhance their ability to continue to offer telehealth.

CONCLUSIONS

Frontline physicians who treated older adults during the COVID-19 pandemic were largely in favor of continuing telehealth use beyond the pandemic; however, they noted that sustainability would depend on enacting policies that address access inequities and reimbursement concerns. Our data provide policy insights that if placed into action could facilitate the long-term success of telehealth and encourage a more flexible healthcare delivery system in the US.

Harnessing Event Report Data to Identify Diagnostic Error During the COVID-19 Pandemic

INTRODUCTION

COVID-19 exposed systemic gaps with increased potential for diagnostic error. This project implemented a new approach leveraging electronic safety reporting to identify and categorize diagnostic errors during the pandemic.

METHODS

All safety event reports from March 1, 2020, to February 28, 2021, at an academic medical center were evaluated using two complementary pathways (Pathway 1: all reports with explicit mention of COVID-19; Pathway 2: all reports without explicit mention of COVID-19 where natural language processing [NLP] plus logic-based stratification was applied to identify potential cases). Cases were evaluated by manual review to identify diagnostic error/delay and categorize error type using a recently proposed classification framework of eight categories of pandemic-related diagnostic errors.

RESULTS

A total of 14,230 reports were included, with 95 (0.7%) identified as cases of diagnostic error/delay. Pathway 1 (n = 1,780 eligible reports) yielded 45 reports with diagnostic error/delay (positive predictive value [PPV] = 2.5%), of which 35.6% (16/45) were attributed to pandemic-related strain. In Pathway 2, the NLP-based algorithm flagged 110 safety reports for manual review from 12,450 eligible reports. Of these, 50 reports had diagnostic error/delay (PPV = 45.5%); 94.0% (47/50) were related to strain. Errors from all eight categories of the taxonomy were found on analysis.

CONCLUSION

An event reporting-based strategy including use of simple-NLP-identified COVID-19-related diagnostic errors/delays uncovered several safety concerns related to COVID-19. An NLP-based approach can complement traditional reporting and be used as a just-in-time monitoring system to enable early detection of emerging risks from large volumes of safety reports.