COVID-19, telehealth and staff shortages complicate safety and quality measures

While 2021 was a year of innovations in how care is delivered to adjust to the COVID-19 pandemic, big questions remain about how some of these changes are impacting hospital quality and safety.

Though the pandemic affected every community, many localities have shouldered a disproportionate share of COVID-19 hospitalizations, deaths and job losses. Those factors will need to be considered when regulators determine how to measure hospital performance for the Medicare star ratings program, said Dr. Rishi Wadhera, a health policy researcher and assistant professor at Harvard Medical School.

“We need to think about how the broader context—in terms of public health and economic shock—affected the trajectory of outcomes in specific communities, and how that affects our assessment of how well hospitals are doing,” Wadhera said.

Hospitals, regulators and others in the industry will also start to address how to measure and maintain safety when care is delivered via telehealth. Virginia Mason Franciscan Health is monitoring telehealth quality through patient satisfaction surveys, and will look at other factors next year, said Charleen Tachibana, senior vice president and chief quality, safety and patient experience officer at the Seattlebased health system, which is part of CommonSpirit Health.

“We have a lot of population health metrics that we can measure,” Tachibana said. “If the management of that disease process is not evolving in the direction we’d want it to,” then the hospital could look at bringing patients back for in-person visits, she said.

More hospitals, mindful of the safety and quality risks associated with staff shortages and inexperienced workers, will use virtual nurses to provide a second set of eyes and advice for front-line professionals, Tachibana said.

“You can’t just put a new nurse into an unknown environment and expect them to know what they have to do. An experienced mentor will help you not to make any errors,” said Dr. Brigitta Mueller, executive director for patient safety, risk and quality at ECRI. “For an inexperienced person, it might seem logical to do a task slightly different than what the rule says, but the experienced person will be able to tell you, ‘This might not be a good idea.’ ”

ECRI also expects natural-language processing products will become the go-to way hospitals, accreditors and regulators will assess what led to adverse safety events by mining clinician notes, which is currently a manual process.