Curbside Consult with Dr. Jayne 3/16/26

Mr. H recently mentioned the ECRI “Top 10 Patient Safety Concerns” list. It highlights this year’s 10 “most critical patient safety challenges anticipated to impact the healthcare industry.”

I appreciated one of the particular call to action paragraphs in the report:

For decades, safety advocates have made the case for patient safety on moral grounds. That foundation remains unshakable, but there’s an equally compelling financial argument that’s impossible to ignore. Unsafe care isn’t just dangerous; it’s expensive.

The report goes on to highlight the $17 billion annual cost of preventable adverse events in US hospitals. More than 12% of health-related spending in high-income countries involves managing the downstream effects of safety issues.

I’ve tried to make that point to organizational leaders countless times over the last two decades. Sometimes it’s difficult to convince them that the math works. Despite growing financial penalties for quality mishaps, organizations still put themselves at risk because they can’t find the budget to do more than pay lip service to risk mitigation.

Not all remedies are expensive. Some are as straightforward as revisiting roles and responsibilities documents to make sure that processes are clearly assigned and managed. It could also involve taking advantage of new technology features that the organization is paying for but hasn’t yet implemented, resulting in waste. It’s foolish as well as dangerous to fail to embrace revenue-neutral process changes.

The report notes that patient safety concerns are systemic, and that addressing them requires work in four categories: culture, leadership and governance; patient and family caregiver engagement; workforce safety and wellbeing; and learning systems.

Topics nominated for the list were reviewed by experts in medicine, nursing, pharmacy, human factors engineering, quality, risk management, patient safety, and technology. They were ranked by severity, frequency, breadth of patient impact, insidiousness, and visibility. The report notes that organizations can’t address every concern, but should use available tools to identify their risk scores and perform a gap analysis against the recommendations.

Concerns with AI-powered diagnostic tools made the top of the list. One that caught my eye was that some models are more accurate when prompts are created using textbook-style descriptions instead of being formulated based on conversations with standardized patients.

The authors noted challenges with AI detection of certain types of cancers or rare diseases, even in areas where AI has a long track record of helpfulness, such as supporting diagnostic radiology.

Those of us working on AI projects deal every day with bias, lack of transparency, challenges with users being able to identify hallucinations, and erosion of clinicians’ critical thinking skills.

Solid action recommendations include AI usage policies, governance, appropriate training, documentation of when and where AI is being used, disclosure of such to patients, usage of human factors assessments and engineering tools, processes to document concerns, and ensuring that critical thinking skills are emphasized in staff training.

These are processes that organizations typically have in their toolkit for other technologies or interventions. Leaders shouldn’t have to reinvent the wheel to begin to take action just because it’s a new technology.

Number two on the list is increasing health risks and disparities caused by reduced access to rural healthcare. Rural hospitals have been at risk of closure for years, and more and more patients are finding themselves living in healthcare deserts. Private equity firms swooped in to buy hospitals and then saddled them with debt, sometimes destroying the community’s healthcare ecosystem.

Rural hospitals can’t achieve the economies of scale that larger organizations might, which increases the cost of care. Rural areas also may have higher percentages of Medicare and Medicaid patients, which tips the equation even more to the negative.

The report calls for expanding telehealth and telepharmacy services, creating mobile health clinics for primary care and preventive services, and partnering with community organizations to educate patients. It also recommends looking at transportation programs to improve patient access and partnering with educational and government organizations to improve recruitment and retention of rural health workers. There are certainly costs for programs like those, which will make this issue challenging to solve. 

I wasn’t surprised by the third item on the list, the increasing rates of diseases that are preventable, especially those for which effective vaccines exist. I never thought that I would see myself practicing in the middle of a measles epidemic, especially since until last year I was one of few clinicians in my area who had actually seen the disease.  I wish that club was still exclusive, but now many of my colleagues have seen the disease in the community. The report also calls out pertussis (whooping cough) as well as dysentery as re-emerging diseases in the US. 

Item number four is the impact on healthcare operations and patient safety of federal funding cuts to Medicaid, Medicare, and grants to educational and care delivery organizations. 

Item five is the lack of recognition and reporting of harm events. That surprises me given the push for reporting in organizations that I’ve worked in. It saddens me to think of institutions that don’t have a strong safety culture, but based on some of the lawsuits that I see filed, they are out there.

Sixth on the list is inequitable pain management that is received by women due to implicit bias and inconsistent guidelines. The report notes the frequency with which women’s pain is thought to be psychological or hormonal rather than being driven physical causes. Evidence also exists that women of color are more likely to have their reports of pain underestimated or dismissed compared to white patients. I’ve certainly seen this in practice more than I would like, so I’m glad it made the list.

Number seven should be no surprise to anyone: workforce shortages with resulting staff burden and decreased access to care.

Eighth on the list is the negative impact of a “culture of blame” on learning and system improvement, which is also not shocking.

The contribution of emergency department boarding to worse patient outcomes made the list at number nine. I’ve worked in a busy emergency department and had to manage patients well outside my scope of practice. Let me tell you that can be terrifying, especially if you are in a community or rural facility with no backup. I did that kind of work in the days before telemedicine, which supposedly that helps to some degree, but it’s still ultimately on the shoulders of the physician in the room. I hope that the boarding problem continues to receive attention.

Rounding out the list at number 10: medication safety issues due to gaps in manufacturer packaging and labeling design. I’m familiar with medication-related confusion with patients, but those of us outside the inpatient realm might not think about clinician confusion involving injectable medications and infusions. The report notes that confusion is most common when manufacturer package branding makes medications look similar when they are in fact quite different.

The report notes that barcode scanning could be helpful, and I agree, although I had my own medication safety issue during a hospital stay when the nurse scanned the package after she had already administered it. Needless to say, a sternly worded letter was crafted, and I hope the situation was addressed.

I encourage readers, even those who aren’t in a patient safety-related role, to download the report and take a look. Most of us are patients to some degree, and all of us will be patients at some time in the future. It’s important to understand these risks so you can have a plan if you or a loved one has to seek care, particularly in a hospital or emergency department.

What patient safety risks didn’t make the list? Would you have ranked them differently? Leave a comment or email me.

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