March 15, 2023 – The pediatric mental health crisis, compounded by the COVID-19 pandemic, is the top patient safety concern in 2023, according to a new report of a major American research and patient safety company.
“Even before COVID-19, the impact of social media, gun violence, and other socioeconomic factors caused high rates of depression and anxiety in children,” Marcus Schabacker, MD, PhD, president and CEO of the ECRI research group, said in A press release. “The challenges caused by the pandemic have turned a bad situation into a crisis. We are approaching a national health emergency.
According to a study in JAMA Pediatrics, rates of anxiety and depression among children aged 3 to 17 increased by 29% and 27%, respectively, from 2016 to 2020. was 39% higher in the winter of 2021 than in the winter of 2020, the CDC documented. And one 2021 CDC Survey US high school students found that 30% of girls said they had seriously considered attempting suicide, double the rate among boys and an increase of nearly 60% from a decade ago. Almost half of LGBTQ students said they had considered suicide.
ECRI, an independent non-profit organization dedicated to improving the safety, quality and cost-effectiveness of healthcare, has made several recommendations to address the pediatric mental health crisis. Among other things, ECRI experts have suggested carrying out universal mental health screenings for children at every practice and hospital visit. Additionally, they recommended that primary care providers perform “warm transfers” of patients and families to therapists they trust.
In an interview, Schabacker said it’s not enough for a primary care provider to simply tell a child’s parents to choose a therapist from an insurance list and book an appointment. The clinician should refer the patient to a mental health professional they know well, whether it is a therapist in private practice or an employee of a school or church. Additionally, he said, the practitioner must ensure that the therapist has the correct information about the patient and knows why they were referred.
Doctors also need to be made aware of the extent of the crisis and the long-term effects of untreated mental health issues, Schabacker said. And they should keep in mind that LGBTQ, minority, and/or socially disadvantaged children have a much higher risk of severe mental breakdown than heterosexual white children.
How staffing shortages affect security
Since the start of the pandemic, staffing shortages in hospitals and medical practices have affected several of the top 10 security issues, according to ECRI. Staff shortages were in fact the main security concern in ECRI’s 2022 report. Among other things, these shortages played a role in safety issue number two this year: “Physical and verbal violence against healthcare workers”.
If an emergency room is understaffed, for example, it can take a long time for a patient to be seen, and some patients or their family members can become frustrated and angry. They could then confront an ER nurse.
“We’ve seen a dramatic increase in violence against nurses,” Schabacker said. When nurses and doctors are overworked due to a staff shortage, they may not have the patience to calm people down and defuse situations.
Another consequence of staffing shortages is that some healthcare professionals may be “expected to work in areas outside their scope of practice and competence” (item number 4 on the list). This can lead to less effective care, Schabacker said.
“Staffing shortages directly influence 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 things.”
Fallout of Dobbs Decision
Another example of how changes in society are affecting health care is concern number three on ECRI’s list: “The needs of clinicians in times of uncertainty surrounding maternal-fetal medicine”.
This refers to the United States Supreme Court’s Dobbs decision, which overturned Roe v. Wade and referred the issue of the legality of abortion to the states.
Explaining how this change affects patient safety, the ECRI report states: “Uncertainty has now arisen in many states as to what reproductive services can be provided and when. This uncertainty can lead to denial or delays in treatment which ultimately cannot be considered a violation of the law. Although some abortion ban states allow abortions to save life or avoid harm to the pregnant patient, there are often little indication of where the line is. If clinicians wait too long, patients can be seriously harmed.
Obviously, health care providers can’t change the law, but Schabacker said health care organizations are obligated to tell doctors exactly what the law requires.
“If a woman suffers serious health problems during her pregnancy and the doctor does not know exactly what he is authorized to do in these situations, because of the uncertainty created by the decision of the Supreme Court, this leads to a risk and will lead to safety issues and harm to mothers,” he said.
Health care officials need to be proactive and provide clear guidelines on what is allowed and what is not.
Erroneous medication lists
ECRI also denounces “medication errors resulting from inaccurate medication lists for patients”. The report notes that “inconsistent medication knowledge and record keeping causes up to 50% of medication errors in hospitals and up to 20% of adverse drug events.”
Although these medication documentation errors have occurred in hospitals, Schabacker said, medication lists in outpatient care can contain even 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 the omission of drugs from the drug list or the inclusion of discontinued drugs.
