Top patient safety and technology hazards and concerns for 2022

Risks and hazards impacting the healthcare industry will dominate the headlines this year, offering an ever-changing series of concerns in all segments, including acute care, physician practices and senior living, among other areas. Each hazard and risk require keen monitoring to stay ahead of the next “big” issue.

From the recent introduction of hacker robots to the use of block chain in the insurance industry, all bets are off. Any issue, disruption or operation misstep is fair game today. Although the severity and frequency for these events may vary, near miss analysis and data trending will be essential to anticipate future risk.

What are the emerging and evolving risks for 2022? They fall into two major categories: patient safety and technology.

Patient safety

The human issues faced by healthcare systems have exponentially escalated, specifically regarding staffing facilities. Although there have been staffing concerns for many years, the recent pandemic has highlighted the dire situation.

Staffing

• Staff shortages of both clinical and non-clinical professionals, such as RNs, certified nursing assistants, respiratory therapists, registrars and others will continue to dominate.
• Creative work force sourcing will be seeking solutions — from escalated training programs to tapping new markets for securing clinical staff.
• Sourcing from outside the U.S. is not new but, since 2020, the volume of caregivers presenting for work here with English as a second language has boomed.
• Approximately 40% of nurses in the U.S. are over the age of 50. COVID-19 has brought forth worker retirement considerations¹.

Use of travelers/contractors/interim staff

• Contracts with travelers occur quickly, as the goal is to bring the interim worker on as soon as possible. Therefore, opportunities for adequate training and onboarding for interim staff may not be as detailed or sufficient as necessary.
• Contract staff are costly coming in at two to three times the hourly rate of permanently hired staff. The impact of contract staff hits heavy on the bottom line. Money spent on staffing takes away from other operational needs.

Staff safety

• Episodes of violence and aggression in the workplace continue to escalate.
• There is concern with domestic partner violence that may carry over into the work setting.
• Travel risk exists for employees who see patients outside the hospital setting (home health, hospice). Home-based nurse and care teams may often walk into unsafe situations.

Staff physical and mental well-being

• Frontline caregivers are working longer hours resulting in physical and emotional exhaustion putting the team and their core energy reserves to the test.
• Beyond burnout, many are experiencing post-traumatic stress (PTSD) which can create an increase in suicide risks in both physicians and frontline care team members.
• Staff shortages are impacting access to mental health care, with some prospective patients waiting weeks for a first appointment.
• Long COVID-19 symptoms will continue to impact staffing coverage.
• The potential impact of staff shortages on patient safety is under review by regulatory agencies, patient safety forums and accreditation organizations.³

Patient safety

In the complex environment of healthcare today, there are many factors that also influence the quality of patient care delivery.

With less than optimum staffing, best-practice approach to care may not be realized. Poor handoff and care coordination may occur from shift to shift due to staff shortages. Determining whether burnout and stress are also contributors to patient safety is an important topic under review, considering the challenges brought forth by the pandemic.

Patient rights

Patients, when met with refusal from their provider or a member of the care team to order a desired, but not warranted or scientifically validated medication or treatment, may allege an allegation of bias or discrimination. Also, patients who experience an encounter with staff where they feel they were treated harshly may find such behavior reportable. The patient or family may make a complaint against the staff person alleging abuse(physical, mental, emotional, fiscal). Many such instances require prompt review and may result in involving law enforcement and licensing boards reporting.

Technology hazards

Cyber threats

Cybersecurity and ransom attacks continue to grow in number and remain as a prominent concern in all industry sectors. However, hospitals are at a greater risk not only because of a breach of patient information but the potential for compromising patient care directly.

Beyond the desktop computer and the electronic medical record, a significant portion of medical devices found in healthcare settings are at risk for a cyberattack as well. Infusion pumps, patient cardiac monitors and glucometer (for blood testing for diabetics) are the most vulnerable.

Supply chain

Bottlenecks in delivery due to trucking and other transport issues have created demand and a domino effect of unmet need. Healthcare providers are being forced to using inventory that may not be ideal may place the patient at risk.

Looking at an already challenging supply chain, we can also add the potential for a cyber event to further impact and damage the already taxed transportation industry. Inadequate medical device and supply inventory may result in reprocessing of one-time use equipment, which in turn may put the patient at risk for infection.

Continued labor challenges and natural disasters also play a role in supply chain disruptions.⁶

Telehealth/virtual care

Telehealth has been available for some time, particularly for mental health care or underserved communities in need of specialty care. With the pandemic, telehealth, or the virtual appointment, is no longer an exception but now an option for the patient to consider when scheduling to see their provider. Some risks to this delivery process include⁷:

• Physical assessments of the patient may be less than accurate.
• Computer access may be limited for some demographics.
• Privacy may not be assured, and personal health information may be at risk of a breach.
• Connecting online and staying connected throughout the appointment may be an issue.
• Alignment with reimbursement for virtual care could be problematic.

Emergency use authorization

Emergency use authorization (EUA) occurs when current products, drugs or devices are discovered to not meet the need of a newly identified disease. The U.S. Food & Drug Administration (FDA) may step in and allow for such emergency use of a medication or device when no other approved alternatives exist. EAUs allow for temporary use of an unapproved product or off-label use for an existing product.

Use of EUAs is not without risks, such as regulatory problems, loss of certain liability protections and civil suits.⁸

Medication delivery systems

Infusion pumps from a technology risk standpoint appear again here as a hazard and a risk. The pumps are easy to damage, and it is even easier to override internal metrics.

The Pyxis machine (an automated medication storage unit) was created so that the care team could readily access the medications needed for their patients. Overtime, standards, safeguards and metrics were put in place within the mechanics of the device. However, humans can override those protections.

Artificial intelligence (AI)

There are benefits to using AI, specifically in the realm of diagnostics. AI may also offer a future that quite possibly reduces caregiver burnout. Examples of AI include predictive analytics, clinical pathway decision making, wearable tech, off-site or home-based patient monitoring and more.

However, at issue relative to risks and benefits is the possibility that AI may not be able to interpret all human nuances resulting in biases, lapses and unintended consequences in care. The AI system must be consistently monitored and offer checks and balances to ensure safety.

Summary

2022 promises to bring forth continued risks and hazards for the healthcare industry. With less than optimum staffing, a best-practice approach to care may not be realized. Poor handoff and care coordination may occur from shift to shift due to staff shortages.

Ensuring for the safety of healthcare workers is now paramount and a leading priority for healthcare organizations. The concern for employee safety also extends to ensuring patient safety, as both issues go together. Reducing error rates and mistakes will require continued monitoring.

From the front line to senior leadership, employee safety will continue to be one of the highest priorities. In a time of uncertainty, where high emotions are coming from peers, patients and their families, staff need to feel safe and heard. Continually escalating episodes of violence at the workplace likely will further exacerbate burnout, staffing shortages and turnover. Leadership visibility and problem-solving difficult encounters with patients provide emotional staff support.

For a more detailed version of these hazards, please download the full PDF below as a reference guide.

References

¹ ECRI (2022). Retrieved from: https://www.ecri.org/top-10-patient-safety-concerns-2022/

² CDC (2022). Strategies to Mitigate Healthcare Personnel Staffing Shortages. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html

³ Risk & Insurance (2022). Retrieved from: https://riskandinsurance.com/2022s-million-dollar-question-what-will-the-workplace-look-like-coming-out-of-covid/

⁴ OSHA: Workplace Violence in Healthcare (2022). Retrieved from: https://www.osha.gov/sites/default/files/OSHA3826.pdf

⁵ The U.S. Department of Health and Human Services released the Health Industry Cubersecurity Practices: Managing Threats and Protecting Patients in 2019.

⁶ Risk & Insurance (2022). Retrieved from : https://riskandinsurance.com/insurers-are-no-longer-on-the-sidelines-of-blockchain-heres-its-benefits-and-potential-risks/

⁷ Telehealth Risk During Covid-19 and Beyond (2021). Association of Healthcare Auditors. Retrieved from: https://ahia.org/AHIA/media/WhitePapers/AHIA_CROWE_WhitePaper_Telehealth-risks-during-COVID-19-and-beyond_FINAL_12-10-20.pdf

⁸ Risks of emergency use authorizations for medical products during outbreak situations: a COVID-19 case study (2020). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530883/

Disclaimer

Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).

Author

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Joan M. Porcaro

Director, Client Relationship Management

email Email phone +1 480 528 4872

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