Looking at pandemics in the past, there’s a strong possibility of a coronavirus resurgence.
Would hospitals be prepared?
To some extent, the COVID-19 outbreak caught everyone off guard, and so far, the public has been fairly forgiving of the costly missteps made by hospitals.
It’s a tangled issue, of course, and some of the most fateful decisions made by healthcare professionals were based on incomplete information, faulty projections, and policies outside of their control.
Still, medical errors are not inevitable.
If the hospital response to a potential second wave of COVID-19 is characterized by the same failures as the first, it’s unlikely the public will be so understanding.
What Went Wrong At Hospitals During COVID-19?
The U.S. Department of Health and Human Services (HHS) surveyed hospitals in March to identify the biggest hurdles they faced in responding to the COVID-19 pandemic.
After gathering information from hospital administrators at 323 different facilities, the HHS Office of the Inspector General reported that the most common challenges were:
- Accurately testing for patients with known or suspected COVID-19
- Providing appropriate care to patients
- Staffing shortages
- Insufficient personal protective equipment (PPE), supplies, or durable equipment
- Insufficient capacity to handle the increased patient load
At the time, the infection rate was skyrocketing, there was widespread uncertainty about the nature of the virus, and there was a severe global shortage of protective equipment and supplies.
Yet a Wall Street Journal examination revealed that many hospitals cut down on their supplies of PPE in order to maximize profit in recent years. It was a costly miscalculation. Without stockpiles to draw on, many healthcare workers and patients needlessly lost their lives in the early days of the outbreak.
Hospital management shouldn’t be treating PPE like frivolous spending, trimming inventory to increase the bottom line. Being prepared for an emergency is their mandate, not quarterly profits.
It’s a similar story when it comes to medical errors — there are steps that hospitals can take to reduce the harm that human error causes patients.
When hospitals fail to implement responsible policies, people get hurt, and the strain of the pandemic makes a bad problem even worse.
Common Medical Errors During COVID-19
When it comes to the common medical errors reported during the COVID-19 pandemic, there are 3 overarching categories in which these errors fall: Diagnostic, handoff, and medication.
Quickly diagnosing patients is one of the keys to maximizing the efficient use of hospital supplies, as well as the protection of patients and staff. Despite a lot of new knowledge about COVID-19 and its clinical manifestations, human error still contributes to inaccurate diagnoses.
Because of such mistakes, sick patients don’t receive proper care and may not be isolated, which risks spreading the virus.
In cases where a healthy person is misdiagnosed with COVID-19, precious PPE, nursing hours, and physician attention is wasted while a long line of needy patients is forced to wait.
“Even before the pandemic, diagnostic errors (ie, missed, delayed, and incorrect diagnoses) had been one of the leading contributors to harm in health care,” wrote lead author Dr. Tejal Gandhi in a recent article for the Journal of Hospital Medicine. “The COVID-19 pandemic is likely to increase the risk of such errors.”
Gandhi laid out how the atmosphere created by the pandemic is likely to make the serious problem of diagnostic medical errors much worse. The biggest factors identified were:
- COVID-19 is a new disease, and knowledge of symptoms and treatment is still evolving.
- The decision-making of nurses and doctors is influenced by the compromised “physical and psychological safety” of the hospital setting during a surge of COVID-19 patients.
- Staffing shortages and workarounds are common, putting staff in the position of caring for those outside their usual domain, without the usual safeguards of standard practices.
- In especially hard-hit facilities, doctors and nurses are “experiencing epic levels of stress, fatigue, and burnout.”
Summing up their worries, Gandhi and his team of researchers write:
“Decisions in busy, chaotic, and time-pressured healthcare systems with disrupted and/or newly designed care processes will be error-prone.”
To help clinicians make more accurate diagnoses, the authors classify 8 common types of Covid-19 diagnostic errors and strategies to avoid them.
Even under the best of conditions, the “patient handoff” is a common site of miscommunication and medical errors. When care teams turnover between shifts, all of the proper information must be exchanged.
As Dr. John Rusher wrote in a recent article for the American Academy of Pediatrics, “When handoffs are not done responsibly, patients are vulnerable to adverse events and physicians are at risk for malpractice.”
During the COVID-19 staffing shortages, hospitals were expanding capacity into pop-up tents and sports arenas, which greatly increased the chances of an improper handoff. To make matters worse, patients were often in extremely bad condition, making their transfer questionable in the first place.
At times, hospitals lost track of patients altogether. An emergency room doctor at Brookdale University Hospital Medical Center in Brooklyn recalled a harrowing story to the Wall Street Journal. A family member called to inquire about their mother. When the physician looked her up, he discovered that she had died two days before.
“This is happening daily,” the doctor told the Journal when the pandemic was at its peak.
When a patient gets the wrong medication, or the wrong dose at the wrong time, the consequences can be fatal.
The Institute for Safe Medication Practices, a non-profit group focused on prescription drug safety, recently released information about frequent COVID-19-related medication errors hospitals are reporting, including:
- Confusing labeling for Remdesivir: Vials of the experimental antiviral medication Remdesivir have labeling information that is hard to read and inconsistent, leading to errors in dosage.
- Inexperience with bar code medication administration: Hospitals redeploying staff from one setting to another, as a result of COVID-19, has caused medication errors because of staff unfamiliarity with barcode administration, resulting in patients receiving improper medication.
- Limits of telehealth: A patient’s weight can fluctuate without a doctor noticing during a telehealth visit. This can lead to an improper dose being administered.
- Incorrect drugs via ADC: When physicians give verbal orders, rather than entering a prescription into the health record, staff may incorrectly type the name of a drug into an automatic dispensing cabinet (ADC), where medications are stored. In the rushed environment of COVID-19, an increase in the use of verbal orders has resulted in the wrong medication being administered.
- Missed doses: Room visits to sick patients were limited in order to conserve PPE, which meant that medication was not always administered at the proper time. Additionally, communication issues between nurses and respiratory therapists early in the pandemic contributed to missed doses.
Build a Better System for Everyone
The last few months have been a very difficult experience for everyone involved in hospital care: burnt-out staff, scrambling suppliers, frightened patients, and grieving families.
Hopefully, hospitals implement the recent lessons they have learned at great cost.
What can those in power do to make the system more resilient, more equitable, and better support their tireless workforce? The stakes are as high now as they’ve ever been.