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How has the current economy affected patient safety?

From the September 10, 2009 issue

You don’t need a crystal ball to predict that our current economic downturn will take a toll on the quality and safety of healthcare. There are many warning signs(1,2) already that simply can’t be ignored:  

  • Investments, a previously dependable source of revenue for healthcare systems, have lost money(1)
  • Charitable donations, upon which many nonprofit healthcare providers depend, have significantly fallen off(1)
  • Patient volumes have steadily declined as patients postpone elective and non-urgent procedures and forgo preventive care or evaluation of symptoms that may signal life-threatening diseases(1,2)
  • Plans to implement safety-critical technology have increasingly been put on hold, and other capital expenditures have often been frozen. 

These are but a few of the daunting realities in an already resource-strapped healthcare environment that fuel our worry about how much the nation’s current economic crisis will cost us in terms of patient safety. In late 2008, the American Hospital Association reported that more than half of all US hospitals had already cut staffing expenses, and more than a quarter had eliminated or reduced important healthcare services.(1,3) Healthcare providers have made substantial cuts across the board in staff education and external consulting, which brings new knowledge into organizations. Many healthcare leaders have also backed away from resource-intensive safety surveillance, measurement, and assessment activities,(1) hunkering down during the financial crisis.

Spurred by the economy, we have begun to hear about examples of potentially dangerous responses related to medication use:

  • Using multiple-dose vials instead of single-dose vials or prefilled syringes
  • Saving leftover medication in single-use containers for future use
  • Dispensing fewer patient-specific doses
  • Increasing admixture of parenteral solutions by nurses on patient care units
  • Having pharmacy prepare previously outsourced solutions (e.g., cardioplegia)
  • Decreasing unit-based clinical activities of pharmacists so they can assist with dispensing activities due to staff shortages from purposely unfilled positions
  • Allowing low cost to override potential safety issues when making purchase decisions regarding formulary medications
  • Patients increasingly skipping doses or taking smaller doses of medication to reduce the frequency of expensive refills.

Many healthcare providers are feeling the pinch—more of a painful blow—from trying to make do with even less than usual—less money, less staff, less time, less technology, less training. Substantial improvements in patient safety during the past decade did not happen by accident; they occurred because leaders chose to pay attention to patient safety and channel resources into improving it.(1) In today’s economic climate, will our gains during the past 10 years crumble? Will financial considerations trump safety? Are we destined to again drop the ever-fragile “safety” ball as we try to juggle all the dimensions of quality in an economic drought? Or, given that crises have great potential to spur innovation, will we be able to rise to the occasion and develop new ways to maintain and advance patient safety with less money?
    
We are interested in learning how the economy is affecting you and your patients, and how you are working to maintain patient safety and quality. Please take a few minutes to take our survey.) We will publish the results in a future newsletter and share any innovations to help get us through the economic crisis safely.

References:
1) Reinertsen JL, Conway J, Orlikoff JE. Safety in a recession? Trustee Magazine June 2009; accessed at: www.trusteemag.com/trusteemag_app/jsp/articledisplay.jsp?dcrpath=TRUSTEEMAG/Article/data/06JUN2009/0906TRU_DEPT_viewpoint&domain=TRUSTEEMAG.
2) The Joint Commission. Leadership committed to safety. Sentinel Event Alert August 27, 2009; accessed at: www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_43.htm.
3) American Hospital Association: AHA report provides statistics showing hospitals’ struggles with economic downturn. Hospital Review Magazine Nov. 20, 2008.

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