With patient safety slipping, CDC and CMS turn focus to more resilient approaches
After trending in the right direction for almost 20 years, patient safety has declined since the start of the COVID-19 pandemic, according to a new perspective published in The New England Journal of Medicine.
The U.S. system was making significant headway in addressing associated infections and other complications of care. However, COVID-19 has cratered many of those efforts by disrupting normal hospital activities, experts from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) said Feb. 12.
“Unfortunately, these stressors have caused safety problems for both patients and staff,” first author Lee A. Fleisher, MD, chief medical officer and director of the Center for Clinical Standards and Quality at CMS, and colleagues added. “Managing the competing priorities of providing care for large numbers of patients with COVID, as well as for the patients without COVID who need care every day, and of maintaining safety efforts such as robust infection-control practices is both difficult and essential.”
Fleisher et al. noted that the pandemic's quick and severe degradation of patient safety has been particularly troubling.
“We believe the pandemic and the breakdown it has caused present an opportunity and an obligation to reevaluate healthcare safety with an eye toward building a more resilient healthcare delivery system, capable not only of achieving safer routine care but also of maintaining high safety levels in times of crisis,” the authors wrote.
For example, central-line–associated bloodstream infections had decreased by 31% in the five years before the pandemic. But those gains were wiped away by a 28% increase in the second quarter of 2020 compared with that same time in 2019. Increases have also been reported in catheter-associated urinary tract infections, ventilator-associated events, and methicillin-resistant Staphylococcus aureus bacteremia.
So, what can be done?
CMS and the CDC both say they are renewing efforts to focus on enhancing patient safety.
Among other things, the authors said that there will be a renewed effort to review safety practices and push for more "deeply-embedded" solutions that also focus on reducing disparities in care.
In addition, both agencies are looking to expand the collection and use of patient safety data, including maternal health and mental health as well as working with other government and non-governmental organizations to further enhance safety priorities. Data from electronic medical records will also be part of this push, the authors noted.
“The healthcare sector owes it to both patients and its own workforce to respond now to the pandemic-induced falloff in safety by redesigning our current processes and developing new approaches that will permit the delivery of safe and equitable care across the healthcare continuum during both normal and extraordinary times. We cannot afford to wait until the pandemic ends,” the authors wrote.
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