Investigations & innovations: ECRI Institute watch list includes low-tech solutions, high-tech ideas

Do today’s hospitals need humanoid robots greeting visitors, escorting them around the hospital and sensing whether they’re feeling joy, anger or fear? Should nurses try more low-tech, back-to-basics steps to reduce infusion pump errors? Do staff need better systems for deciding which cleaning solution to use on each piece of medical equipment?

In many cases, it’s a question of priorities, one that the ECRI Institute tries to help guide with its annual Top 10 Hospital C-Suite Watch List and Top 10 Health Technology Hazards. This week, engineers at the nonprofit healthcare research organization’s headquarters in Plymouth Meeting, Pa., walked journalists through issues on, or related to, their 2017 lists.

One goal is to identify issues that are bubbling up across healthcare delivery, technology and health policy, factor in questions that are weighing on people’s minds and pick several for a deep dive, including action items, said Diane C. Robertson, director of Health Technology Assessment Information Service at ECRI. Over in the institute’s Health Devices Group, the goal is more focused on dangers, said David Jamison, the group’s executive director. His team aims to “shine a light on things that have the potential to cause death or serious injury.”

Low-tech, low-cost solutions?

For the media briefing, ECRI boiled its watch list down to four categories: user mishaps, patient safety risks, genetic advances and hospital enhancements. The reporters watched as engineers in crisp white lab coats explained how plastic equipment used in tests and procedures can degrade if they are cleaned with the wrong detergent. In worst-case scenarios, cracked plastic and deteriorating hinges can lead to patients’ receiving too much or too little medication, or to the high costs of repairing or replacing damaged apparatus.  Action: Careful adherence to cleaning instructions and ongoing communication with vendors.

Infusion pumps frequently make ECRI’s top-10 list, in part because they estimate a million of the devices are running in U.S. hospitals. When they’re working correctly, the pumps can be life-saving, but a malfunctioning or incorrectly programmed pump can deliver too much or too little of a drug, potentially causing harm or even death. In the past, ECRI has focused on complex challenges with the devices, such as their interface with electronic health records and safety software. This year, ECRI’s team proposed three no-cost, “common-sense tips” for reducing errors.  Action: Nurses should routinely check the drip chamber, regardless of how much confidence they have in the device or their programming; use the roller clamp; and inspect the pump for damage to hinges, tubing, etc.

In ECRI’s Accident and Forensic Investigations Group, specialist Christopher Schabowsky demonstrated how he examines surgical staplers for malfunction or misuse. The devices look simple, but they are among the most commonly sent by hospitals to ECRI for “blind” analysis, meaning the ECRI engineers don’t know the device’s history, only that it needs to be studied for potential to misfire or jam.  Action: Follow the instructions for use, keep extra staplers and staples on hand in case the surgeon sees or senses a problem (sometimes it’s as simple as hearing a “funky sound” or the device not feeling right when fired) and have a plan for sequestering or studying devices suspected to be faulty.

High-tech enhancements?

On the other end of ECRI’s surveillance spectrum are innovations that may not make it to prime time. Pepper, the robot reminiscent of Star Wars’ C3PO that could replace human greeters in hospitals, might someday be able to take a patient’s blood pressure and enter the data into the electronic health records, but it could come at the expense of thousands of dollars in programming and maintenance.

Newer LED-ultraviolet lights could help combat hospital-acquired infections, which affect at least 1 in 25 patients in the U.S., but questions need to be answered about the risks they could pose as well as where they would have value. They’re not going to replace old-fashioned “friction cleaning,” said infection prevention specialist James Davis IV. 

Liquid biopsies could spare patients the anxiety and discomfort that often accompany tissue biopsies, but there are conflicting results and additional questions to be examined. And genetic tests aimed at determining whether individual patients are at greater or lesser risk for opioid addiction are not ready for prime time, said Robertson. The evidence isn’t there yet, she said, but trials are underway and the ECRI Institute is watching.