COVID-19 shines new light on old problems with our hospital system, and some solutions make more sense than ever

Practice Management

This year's annual report on the "Top Threats to Patient Safety" by the independent nonprofit research group Emergency Care Research Institute is valuable as always for the attention it draws to specific challenges facing our healthcare system. The 2022 list includes shortages and other stressors on healthcare professionals, international supply chain disruptions, suboptimal tech systems, and a resurfacing of perennial issues from past ECRI reports like inadequate sterilization systems.

ECRI researchers also help put these deep and complex challenges in historical perspective — COVID-19 may have seriously strained our nation's delivery institutions, worsening patient safety in undeniable ways. But the pandemic is only an accelerant, not the cause, of our crisis. The real threats have been here for a long time.

At the epicenter of the COVID-19 crisis, hospitals may be the clearest proof point. Urgent care, especially related to infectious diseases, will doubtless be vastly improved by what we are learning from our response to the pandemic, but only if we return to the underlying fault lines in the system.

Likewise, hospital-based elective care is entering a new era of innovation, triggered by COVID-19 but along a trajectory that was already in place. Contrary to the popular narrative, many of the specialists I work with report that their practices declined only by 20 to 30 percent during the height of the pandemic, which means that the majority of elective procedures like elective orthopedic surgery are better prepared today because solutions were tested and in some cases proven during the past two years.

Top of ECRI's list is healthcare staffing shortages, which we may be tempted to see as part of the "Great Resignation" triggered by the pandemic. But our hospitals have labored for decades with outdated care delivery modalities and inadequate technological support systems that burn out healthcare professionals and perpetuate opportunities for human error that can endanger patient health.

We would have learned nothing if our response to today's staffing shortage is another recruitment effort to fill the same old jobs. Solving the underlying systemic flaws means we must reengineer some jobs so they are more efficient and less stressful. Strategic outsourcing also makes sense for some high-volume tasks that tax hospital staff and resources, especially those that are also essential to patient safety, like OR instrumentation and device sterilization and supply access.

David Caminear, DPM, a foot and ankle surgeon with Hamden-based Connecticut Orthopedics who operates at Yale New Haven Health, Yale New Haven Hospital, has managed change while maintaining patient safety for more than 25 years.

"Foot and ankle surgery, as well as many other orthopedic surgical procedures, had started to shift from hospitals to outpatient surgery centers at least 20 years ago. Patients feel more comfortable in the smaller surgical center setting that reduces their contact with nonessential staff members, which we now see as important for reducing postoperative and hospital-borne infections.

"More recently, as long as external experts are part of the extended team to compensate for the smaller surgery center infrastructure, providing off-site support like pre-sterilization and automated supply inventory management through systems like RFID, I have been able to streamline and improve quality control. This allows me to provide successful and safe care while also adding efficiency to my procedures. It feels like a solid solution to a number of problems," Dr. Caminear explained.

Solutions like these are part of the untold COVID-19 story because they are helping the nation's hospital system evolve. In our rush to return to a new normal, we must not revert to practices that were broken long before the pandemic. Orthopedic surgery, along with many other types of elective care, is emerging healthier and safer than ever with these tools and support procedures in place.

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