ECRI on Monday released its list of the "Top 10 Patient Safety Concerns" for 2023, with the pediatric mental health crisis and violence against healthcare workers topping the list.

How ECRI created the list

For this year's list, ECRI, the nation's largest nonprofit patient safety organization, and the Institute for Safe Medication Practices (ISMP) analyzed scientific literature, patient safety events, concerns reported to or investigated by either organization, and other various internal and external data to identify the most pressing issues impacting patient safety.

For each topic, a cross-departmental team of ECRI and ISMP experts analyzed supporting evidence and evaluated its potential impact using the following criteria:

• Severity: How seriously would patients be harmed if this safety issue occurred?
• Frequency: How likely is this safety issue to occur?
• Breadth: How many patients would be affected if this safety issue occurred?
• Insidiousness: Is this issue difficult to recognize or challenging to address once it occurs?
• Profile: Would this safety issue put significant pressure on an organization?

Once identified, subject matter experts then developed recommendations aimed at addressing these issues.

ECRI's top 10 patient safety concerns for 2023

The top 10 patient safety concerns for 2023 are:

1. The pediatric mental health crisis
2. Violence against healthcare staff
3. Uncertainty with maternal-fetal medicine
4. Clinicians working outside their scope of practice
5. Delayed sepsis treatment
6. Care coordination for complex medical conditions
7. Not going beyond "five rights" of medication safety
8. Inaccurate patient medication lists
9. Accidental use of neuromuscular blocking agents
10. Preventable harm due to missed care

According to Modern Healthcare, ECRI's 2023 list "suggests patient safety concerns have shifted from focusing on the direct effects of COVID-19 to more longstanding, evergreen issues stemming from the pandemic."

Although this year's list does not include many previous issues, including 2022's top concern of understaffing, Patricia McGaffigan, VP of the Institute of Healthcare Improvement, said that many prior concerns are still impacting areas of this year's list.

For example, staffing shortages have led to adverse care coordination and medication administration events. "There's a certain interdependency and connectedness here that is vital," McGaffigan said.

Marcus Schabacker, president and CEO of ECRI, said that instead of viewing these issues as individual events that need to be addressed, stakeholders must make a comprehensive effort to prevent harm.

"We have not made enough progress when it comes to patient safety," Schabacker said. "What's lacking is the total system safety approach. It starts with a culture of leadership and the governance you put in place where there's a deep and believable commitment to safety."

According to the report, a total systems safety approach, which was developed by the National Steering Committee for Patient Safety, consists of four interdependent foundations:

• Cultivating leadership, governance, and cultures that are deeply committed to patient safety
• Engaging patients and families as partners to design and produce care
• Encouraging a healthy, safe, and resilient workforce environment
• Supporting continuous and shared learning to improve safety and quality of care while reducing the risk of harm

Overall, McGaffigan said health systems should see these top patient safety concerns as issues already happening in their organizations and consider what factors could be contributing to patient harm.

"If we keep putting piecemeal solutions in place without addressing the wider opportunities, we'll continue to see some of these challenges remain on the list for years to come," she said. "What's essential is improving the ecosystem of safety to support all of the concerns that could arise." (Devereaux, Modern Healthcare, 3/13; ECRI, PR Newswire, 3/13; ECRI, "Top 10 Patient Safety Concerns 2022," accessed 3/13)