The pediatric mental health crisis tops ECRI’s 2023 list of most pressing patient safety concerns. The nation’s largest nonprofit patient safety organization notes that, while rates of depression and anxiety in children have increased since 2017, the COVID-19 pandemic has elevated the situation to crisis levels.
“Even before COVID-19, the impact of social media, gun violence, and other socioeconomic factors were causing elevated rates of depression and anxiety in children,” said Marcus Schabacker, MD, PhD, president and CEO of ECRI. “The challenges caused by the pandemic turned a bad situation into a crisis. We’re approaching a national public health emergency.”
According to a study in JAMA Pediatrics, rates of anxiety and depression in children aged 3 to 17 increased by 29% and 27%, respectively, in 2020 compared with 2016. The mean weekly number of emergency department visits for adolescent suspected suicide attempts was 39% higher in winter 2021 than in winter 2019, according to the Centers for Disease Control and Prevention.
“As with many medical issues, this crisis is disproportionately affecting historically marginalized communities,” said Dheerendra Kommala, MD, chief medical officer at ECRI. “Structural barriers and bias block access to high-quality mental healthcare for youth of color and LGBTQ youth despite the fact they are more likely to experience depression and anxiety, and attempt suicide at higher rates.”
ECRI’s experts identify several recommendations to address the crisis including performing universal mental health screenings during every office and hospital visit, making personal connections between pediatric mental health providers and patients/families (i.e., warm handoffs), and providing additional support to address social determinants of health.
The top 10 patient safety concerns for 2023 are:
- The pediatric mental health crisis
- Physical and verbal violence against healthcare staff
- Clinician needs in times of uncertainty surrounding maternal-fetal medicine
- Impact on clinicians expected to work outside their scope of practice and competencies
- Delayed identification and treatment of sepsis
- Consequences of poor care coordination for patients with complex medical conditions
- Risks of not looking beyond the “five rights” to achieve medication safety
- Medication errors resulting from inaccurate patient medication lists
- Accidental administration of neuromuscular blocking agents
- Preventable harm due to omitted care or treatment
Some issues on the safety concerns list are related to specific clinical practices and device malfunctions, but many are exacerbated by ongoing staffing shortages—including the pediatric mental health crisis, violence against healthcare staff, mismatches between assignments and competencies, poor care coordination, and missed care opportunities.
“Addressing the healthcare worker shortage will not solve all problems, but it would have a measurably positive effect for providers and patients,” said Schabacker.
According to the report, the solutions to these challenges are usually complex and require a systems-based approach that considers the impact that strong leadership, patient and family engagement, focus on workforce safety, and a robust learning system can have on safety.
ECRI and its affiliate, the Institute for Safe Medication Practices (ISMP), analyzed a wide scope of data to identify the most pressing threats to patient safety, including scientific literature, patient safety events, concerns reported to or investigated by ECRI and ISMP, client research requests and queries, and other internal and external data sources. The recommendations in this report are intended to help healthcare organizations create organizational resilience to navigate these threats and strive for total systems safety.
ECRI’s Top 10 Patient Safety Concerns for 2023 provides detailed steps that organizations can take to prevent adverse incidents and is available for download.