Key Trends and Cautionary Tales: Staffing Shortages and Patient Safety
By Ann Fiala, RN, BSN, CPHRM, CHC, CHPC
Ask any healthcare executive to name the biggest issue that will demand their attention in 2022, and the response will be staffing shortages and their impact on patient safety.
Those focused on improving care quality might consider how key trends will play out and the impact of current industry challenges on their healthcare ecosystem.
One in five healthcare workers have quit their jobs in the last two years
A recent national poll found 20% of healthcare workers have left their jobs In the previous two years (Morning Consult, 2021). Reports indicate that 1 million nurses will retire by 2030 and 30% of RNs are at risk of leaving their organization (American Association of Colleges of Nursing, 2020; Press Ganey, 2021). At the same time, more than 71 million baby boomers face health problems associated with aging (Statista, 2021).
Analysts fear there will be too many patients for the system—and too few healthcare staff to properly care for them.
Consequences for quality and patient safety
Without safe staffing ratios, medical professionals may be forced to care for more patients than they can safely manage. The consequences can be dire.
While little U.S. data is available to quantify the shortages’ effects on patient care (Agency for Healthcare Research and Quality data can lag by several quarters), a 2021 report found that after years of steady decline, healthcare-associated infections rose dramatically in 2020 (Weiner-Lastinger et al., 2021). Researchers attributed the increase to staffing shortages and high patient volumes.
Looking outside the United States, a 2021 Chilean study revealed that for each patient added to a nurse’s workload, there were significant increases in patient mortality, readmission, and length of stay (Aiken et al., 2021).
Keep an eye on these three trends
Recent analyses reveal three notable trends—and cautionary tales—for leaders striving to mitigate staffing shortages’ impact on patient safety:
1. Healthcare teams are evolving. As health systems look for solutions to ongoing staffing shortages, trends indicate that care teams will take a new shape in 2022. However, this evolution may come with significant risk.
The number of participants in a patient’s care journey can be overwhelming. Close to 80% of healthcare organizations plan to incorporate advanced practice providers (APP) into specialty care settings because of critical staffing shortages (SullivanCotter, 2020). At the same time, the hospitalist model has gained momentum, leading to fewer private-practice primary care and specialty physicians making rounds to visit their patients in the emergency department or hospital unit.
The result is an environment ripe for risk. APPs’ insight into the pieces of the patient’s medical record Is sometimes less clear than that of other providers. Legal experts’ recent analysis of malpractice claims data revealed that 19% of care transition events involved an APP (Hanscom et al., 2021).
2. Communication is imperative (and verbal is not enough). As staffing ratios rise and demands on healthcare providers increase, care delivery can become rushed, and communication suffers.
One notable study estimated that 80% of serious medical errors involved miscommunication during a handoff between medical providers (Solet et al., 2005). During transition-related events that trigger malpractice claims, communication is the third most frequent risk issue (Hanscom et al., 2021). Experts believe that a rise in communication-related claims will continue to create significant economic burden and exacerbate health inequities.
3. New care transition models are emerging. More models for improvement will be introduced as we shed light on the risks and costs of care transitions.
Claims stemming from care transitions are 29% more costly than claims arising from other allegations (Hanscom et al., 2021) and often result in financial penalties through reduced reimbursement from the Centers for Medicare & Medicaid Services and other insurers.
New evidence-based models show promise, such as programs led by pharmacists or utilizing pharmacy technicians. Transition clinics are supporting high-risk populations, and videoconference-based programs are reaching patients in remote, under-resourced communities.
Process improvements vital amidst worsening staffing crisis
2022 may bring optimism, even amidst the staffing crisis, if we can reflect on these trends and address critical areas of exposure. By investing in process improvements to help care teams navigate new workflows, additional colleagues, and new care transition models, healthcare organizations can meet the needs of patients whose care begins In, ends In, or transitions through their purview.
References
Aiken, L. H., Simonetti, M., Sloane, D. M., Cerón, C., Soto, P., Bravo, D., Galiano, A., Behrman, J. R., Smith, H. L., McHugh, M. D., & Lake, E. T. (2021). Hospital nurse staffing and patient outcomes in Chile: A multilevel cross-sectional study. The Lancet, 9(8), E1145-E1153. https://doi.org/10.1016/S2214-109X(21)00209-6
American Association of Colleges of Nursing. (2020, September). Fact sheet: Nursing shortage. https://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet.pdf
Hanscom, R., Small, M., Fiala, A., Bennett, P., & Ricci, B. (2021, September). Care transitions: Through the lens of malpractice claims. Coverys. https://www.coverys.com/knowledge-center/a-dose-of-insight-care-transitions
Morning Consult. (2021, September). National Tracking Poll #2109015, September, 2021. https://assets.morningconsult.com/wp-uploads/2021/10/04064018/2109015_crosstabs_MC_HEALTH_HEALTHCARE_WORKERS_Health_Care_Workers_v2_CC.pdf
Press Ganey. (2021, September 30). New findings from Press Ganey reveal millennial nurses are most likely to quit, and nearly 30% of nurses are at risk of leaving their organization. https://www.pressganey.com/about-us/news/new-findings-press-ganey-reveal-millennial-nurses-are-most-likely-quit-and-nearly-30
Solet, D. J., Norvell, J. M., Rutan, G. H., & Frankel, R. M. (2005). Lost in translation: Challenges and opportunities in physician-to-physician communication during patient handoffs. Academic Medicine, 80(12), 1094-1099. https://doi.org/10.1097/00001888-200512000-00005
Statista. (2021, June). Resident population in the United States in 2020, by generation. https://www.statista.com/statistics/797321/us-population-by-generation
SullivanCotter. (2020, May 27). Market response to COVID-19: Physician and advanced practice provider compensation practices survey: Report II. https://sullivancotter.com/wp-content/uploads/2020/05/2020-COVID-19-Physician-and-APP-Compensation-Practices-Survey-Report-II_May.pdf
Weiner-Lastinger, L. M., Pattabiraman, V., Konnor, R. Y., Patel, P. R., Wong, E., Xu, S. Y., Smith, B., Edwards, J. R., & Dudeck, M. (2021). The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network. Infection Control & Hospital Epidemiology, 43(1), 12-25. https://doi.org/10.1017/ice.2021.362