COVID-19: The dark side and the sunny side for patient safety

Abstract

The COVID-19 crisis has placed an enormous strain on our hospitals and health systems. Caring for the rapidly evolving needs of patients has triggered radical changes in the organization and delivery of services. Some hospitals transformed into huge pulmonary critical care units. Most drastically curtailed the usual elective procedures and preventive care to accommodate the flood of patients requiring intensive care for coronavirus disease. The terrible consequences of the pandemic are obvious, with millions infected, and hundreds of thousands dead, many of them spending their last days separated from their families and loved ones. The injuries to society may be even deeper, with businesses closed, some permanently, and hundreds of millions out of work. Education and entertainment have been shuttered. Economies have suffered a body blow, as in the US, which in the second quarter of 2020 had the steepest drop in economic output on record. Food and personal protective supplies are imperiled. The health and economic burdens have been borne disproportionately by the poor and vulnerable. This pandemic has also created new problems with patient safety and health care quality at multiple levels of the system. Examples are missed and delayed diagnoses, caused by clinicians' cognitive biases or patients' reluctance to seek care for urgent problems. Another is medical errors made by inexperienced practitioners. A third is failures in infection prevention and control practices On the other hand, as suggested in 1959 by then Senator John F. Kennedy in an address to the United Negro College Fund, crises can create important new opportunities. 1 In general, they inspire rapid problem solving and innovation. New talent can emerge and assert itself. Unprecedented levels of cooperation can develop, even among rivals. Barriers are lowered and changes in policy and systems can muscle in. All of these developments can lead to increased resilience for the next event. And there have been early signs that the response to the pandemic has had some benefits for patient safety. To explore this, we consulted with safety experts on our international editorial board. We asked them to report on the threats to safety and health care quality that they have identified. We also asked them to report on any silver linings they have observed, and to provide advice about the ones most important to preserve.

The COVID‐19 outbreak in Saudi Arabia and the impact on patient safety incident reports: An empirical study among the medical facilities of Qassim health cluster

“…Indeed, in a recent article published in 2020, a group of diverse researchers agreed that the COVID‐19 pandemic may result in many positive changes in health care, such as upgraded coordination and quality. These changes could be realized through strong commitments to a shared goal, building innovative solutions, and transforming failures into lessons and motivators to achieve future success 18 . Our results are inconsistent with the results of the data from a UK study 12 , which reported a statistically significant reduction in PSIRs after the COVID‐19 crisis.…”

The masks are off–maintaining gains in patient safety post COVID-19

“…The pandemic had a few more silver linings for patient safety and health care quality. 7 There has been an increased appetite for data, the more local the better. The Johns Hopkins COVID-19 dashboard achieved celebrity status.…”

“…My own institution had already begun to wean itself from just-in-time procurement and to improve stockpiling. 7 During the pandemic, it became apparent that this infrastructure was a key component of the COVID-19 response.…”

“…This new approach resulted in greater success in vaccination and other infection control measures. 7 In this issue of the Journal, Al Abbasi and colleagues describe how in response to COVID-19, their pharmacy department implemented a drive-through pharmacy and home-delivery service to ensure patient safety. 12 These services also improve convenience for patients and are likely to be retained beyond the pandemic.…”

Guidance vs. guidelines: the role of evidence-based medicine in the COVID-19 pandemic

“…We must be discerning with what we read and avoid the cognitive biases introduced by anecdote, sensationalism, and fear. 10 We must enroll our patients in clinical research, trials, and cohort studies whenever possible. We need to collect data and contribute to the collective effort to build a foundation of knowledge and scientific evidence.…”