March 15, 2023 — The pediatric mental health crisis, worsened by the COVID-19 pandemic, is the top patient safety concern for 2023, according to a new report from the US’s top patient safety and research organization.
“Even before COVID-19, exposure to social media, gun violence and other socioeconomic factors were causing high rates of depression and anxiety in children.” ECRI Research Group President and CEO Markus Schabaker said in a press release: “The challenges caused by the epidemic turned a bad situation into a crisis. We are approaching a national health emergency.”
According to the study JAMA PediatricsRates of anxiety and depression among children aged 3 to 17 increased by 29% and 27% between 2016 and 2020, respectively. The average number of emergency department visits per week for suspected teen suicide attempts was 39% higher than in the winter of 2021. In the winter of 2020, the CDC stated: And in 2021, a CDC survey of US high school students found that 30% of girls said they had seriously considered trying to commit suicide, twice as many as boys and nearly 60% more than once. decade ago. Nearly half of LGBTQ students said they had thoughts of suicide.
ECRI, an independent nonprofit organization dedicated to improving the safety, quality, and cost-effectiveness of health care, has made several recommendations to address the child mental health crisis. Among other things, RAEC experts recommended universal child mental health screenings at every office or hospital visit. In addition, they recommended that primary care providers make “warm handoffs” of patients and families to therapists they trust.
In an interview, Schabaker said it’s not enough for a primary care provider to simply tell a child’s parents to pick a therapist from an insurance list and make an appointment. The doctor should refer the patient to a mental health professional they know, whether it’s a therapist in private practice or a school or church worker. In addition, he said, the practitioner should make sure the therapist has the correct information about the patient and knows why he or she was referred.
Doctors also need to be made aware of the extent of the crisis and the long-term consequences of untreated mental health conditions, Schabaker said. And they should keep in mind that children who are LGBTQ, minority, and/or socially disadvantaged have a much higher risk of severe mental illness than heterosexual white children.
How staffing shortages affect safety
Since the start of the pandemic, understaffing in hospitals and doctors’ offices has affected the top 10 safety issues, according to ECRI. Staff shortages were, in fact, the top security issue in ECRI’s 2022 report. Among other things, these shortages played a role in the number two safety concern this year: “Physical and Verbal Abuse of Health Care Personnel.”
If the emergency room, for example, is understaffed, it may take a long time to see a patient, and some patients or their family members may become frustrated and angry. They may then see an ER nurse.
“We’ve seen a dramatic increase in violence against nurses,” Schabaker said. When nurses and doctors are overwhelmed by staff shortages, they may not have the patience to calm people down and defuse situations.
Another result of understaffing is that some health professionals may “expect to work outside their scope of practice and competence” (item 4 on the list). This can lead to less effective care, Schabaker said.
“Staff shortages directly affect clinical staff assignments and gaps need to be filled,” he said. “And when you’re constantly on the run, constantly stressed, constantly at your limits, you’re much more likely to miss something.”
Consequence of the Dobbs decision
Another example of how societal changes affect healthcare is the third concern on ECRI’s list:
It refers to the US Supreme Court’s Dobbs decision, which overturned Roe v. Wade and returned the question of the legality of abortion to the states.
Explaining how this change affects patient safety, the RAEC report states: This uncertainty can lead to denial or delay of care which ultimately cannot be considered a violation of the law. Although some states with abortion bans allow abortions to save or harm a pregnant patient, often a little guide to where the line is. If doctors wait too long, patients can suffer serious harm.”
Obviously, health care providers can’t change the law, but Schabaker said health care organizations have a responsibility to tell doctors exactly what the law requires.
“If a woman has serious health events during pregnancy and the doctor is not clear about what she is allowed to do in those situations, because of the uncertainty created by the Supreme Court decision, that creates a risk and will lead to safety events.” and harm to mothers,” he said.
Healthcare leaders need to be proactive and provide clear guidance on what is allowed and what is not.
Incorrect medication lists
ECRI also calls for “medication errors resulting from inaccurate patient medication lists.” The report states that “inappropriate medication knowledge and records lead to up to 50% of medication errors and up to 20% of adverse drug events in hospitals”.
While these medication documentation errors have occurred in hospitals, Schabaker says outpatient care medication lists may contain more errors. “A study conducted in patients’ homes before a doctor’s visit found that medication discrepancies ranged from 14% to 98%,” he said.
The most common examples are omitting drugs from the drug list or including discontinued drugs.