Staffing Shortages, the Nation’s Top Safety Concerns Being Felt Close to Home

Posted on January 31, 2023

My heart hurts following three recent inquires for guidance, support or assistance. On this particular day, what was most unusual, the reason for each caller’s outreach. All as a result of actual experience with, or concern of less-than-favorable quality of care received by themselves or that of a beloved family member. Each of these situations resulted in discharge or transfer following a prolonged hospital stay. Of the three, the most concerning came a 68-year-old, retired RN with diabetes.

My heart hurts following three recent inquires for guidance, support or assistance. On this particular day, what was most unusual, the reason for each caller’s outreach. All as a result of actual experience with, or concern of less-than-favorable quality of care received by themselves or that of a beloved family member. Each of these situations resulted in discharge or transfer following a prolonged hospital stay.

Of the three, the most concerning came a 68-year-old, retired RN with diabetes. Immediately upon answering, she stated, “I need a patient advocate,” then went on to provide her reasons for the declaration. She explained her admission to a subacute rehab occurred following the recent repair of fractured hip in 3 places. Upon admission to a subacute rehab facility on a Friday evening, she was informed by staff of the lack of staffing. She has continued to be a reminded by staff, several times a day.

She informed me she waited, despite her asking, for her patient bracelet (used to identify each individual for the prevention of medication errors, among other things). Finally, it appeared on the 7th day of her admission. Whoever gave it to her, let her know it had been located in her chart.

Other concerns included: despite being scheduled for daily physical therapy, she reported this was not happening due to the lack of staffing; was given insulin although a prior blood sugar check had not occurred; continues to endure up to a one hour waits for response after using the call bell, and in one instance prescribed medication was not given, with the nurse citing, “we don’t have any.” Most troubling , was her comment, “I am afraid I am going to die in here.”

Another inquiry came from the family of patient readmitted to hospital after 3 days at home due sepsis. Given sepsis happens when an infection a patient already has causes triggers a chain reaction throughout the body, and was not discharged with a history of sepsis, it is possible this person was discharged with an infection that lead to sepsis. This type of infection often starts in the lung, urinary tract, skin, gastrointestinal tract, blood stream, wounds or burns and catheter sights.

The last call, also from a family concerned that their family member. An inpatient on 15 liters of oxygen. They wondered how this would happen given the maximum level on the patient’s concentrator is 10 liters per minutes. The average levels of oxygen are prescribed at 2 – 6 liters per minute. Family called concerned physician and case manager are planning for discharge to home in 5 days.

Having been actively advocating on a daily basis, for patients, their families and other care partners for the last two and a half years, each day taking up to 30 or more calls on behalf of a medical transport company, my concern - my heart hurt - is in knowing the sharing of genuine patient care concerns were not voiced any where near the degree by which they are today. Perhaps once or twice a week during the early stages of Covid-19. About six to nine months ago, I began of a growing number of calls, at least one each day.

Doctors and nurses hard work hard for safe care, but it’s no secret they’re stretched and stressed. Undoubtedly, the reason thirty-four percent of doctors report increased medical errors due to staffing shortages.[i]

Since Covid-19, Americans have been enduring longer wait times when seeking care “even in life-threatening emergencies,” or to be turned away entirely. It’s not just nurses. Professionals from medical lab workers to paramedics are in short supply.[ii]

In any high-risk environment (transportation, particularly the airline industry of late) there are powerful systems in place monitoring or alerting for continuous detection of harm and risk, as well as corresponding actions to learn and prevent future harm built into the culture. Sadly, this is not the case in healthcare.

With current working conditions resulting in the loss of nurses, doctors, even porters, there is need for improvement in hospital and other health care facilities. Estimates are 1 in 4 patients have experienced and adverse event.

While healthcare systems, government and private-sector entities, independently require and produce reports for the purpose of determining root cause, analyzing information, inspecting and grading errors and their severity and unlike other industries, there is no national improvement system in place for healthcare. No trusted authority establishing expectations for what good looks like or monitoring causes, risks and harms that are occurring.

From experience in other industries we know a central expert source whose sole role is to make sure continuous improvement to prevent harm works. As an example, the goal in the airline industry is to prevent harm before it occurs.

The need for a national government-led patient safety effort has long been advocated for. Legislation outlining the structure of a federal agency to provide support for patient safety data collection, national incident analysis, and recommendation development surfaced in National Patient Safety Board Act of 2022 currently sits in the House, under review by the Energy and Commerce; Veterans’ Affairs and Education and Labor Committees for review. [iii]

Surely, we can do better.

[i] Medical Economics> Published on: March 21, 2022
Todd Shryock https://www.medicaleconomics.com/view/34-of-doctors-report-increased-medical-errors-due-to-staffing-shortages
[ii] Steven Ross Johnson, Staff Shortages Choking U.S. Health Care System. U.S.News. July 28, 2022.
[iii] Congress.gov. H.R.9377 - National Patient Safety Board Act of 2022. 117th Congress (2001-2022). https://www.congress.gov/bill/117th-congress/house-bill/9377?r=1&s=1