USA - The Emergency Care Research Institute (ECRI) releases top health technology hazards for 2010

Citation

(2010), "USA - The Emergency Care Research Institute (ECRI) releases top health technology hazards for 2010", International Journal of Health Care Quality Assurance, Vol. 23 No. 3. https://doi.org/10.1108/ijhcqa.2010.06223cab.003

USA - The Emergency Care Research Institute (ECRI) releases top health technology hazards for 2010

Article Type: News and views From: International Journal of Health Care Quality Assurance, Volume 23, Issue 3

Keywords: Healthcare technology, Patient safety, Medical device management, United States of America

Superior healthcare technology usually means better care and safety for patients – but the familiar technologies that power today’s modern hospitals also have a dark side. From infections to cancer to surgical fires, this list covers the top healthcare technology threats for 2010.

Released by the ECRI, a federal patient safety organisation, the list was derived from investigations into device-related incidents, as well as from a medical device problem reporting database maintained by ECRI and other organisations.

ECRI officials say the report does not identify a one-size-fits-all solution to all problems, but identifies the most crucial issues facing hospitals. While the dangers described in the report are real and often frightening, the good news is that most risks are preventable. Hospitals should re-evaluate their to-do lists and consider putting these recommendations at the top to avoid bad practices before they result in patient harm.

Cross-contamination from flexible endoscopes

Endoscopy is a minimally invasive medical diagnostic procedure that has revolutionised care in modern hospital settings. However, it has also been the culprit in a disturbing trend of medical personnel exposing their patients to infectious disease. The cause often results from failure to adhere to simple cleaning and sterilisation procedures. Often in these cases, large numbers of patients must be notified of exposure to contaminated endoscopic equipment.

Alarm hazards

Clinical alarms warn caregivers of hazards, and are instrumental in preventing patient injury or death – as long as caregivers get the message. Alarm issues are among the most frequently reported problems, mostly due to the sheer variety of equipment – patient monitoring, ventilators, dialysis units and many others.

Surgical fires

In September of 2009 Janice McCall, 65, was undergoing routine surgery at Heartland Regional Medical Center in Marion, Illinois, when a flash fire erupted and she was burned to death on the operating table. The latest estimates from ECRI put the annual number of surgical fires at around 550 to 650, making them roughly as frequent as other surgical mishaps like wrong-site surgery. Most surgical fires result from the presence of an oxygen-enriched atmosphere during surgeries to the head, face, beck and upper chest.

CT radiation dose

With the recent publication of articles in the New England Journal of Medicine indicating that many CT studies expose patients to an unnecessary risk of cancer, along with a report in October that Cedars-Sinai Medical Center in Los Angeles accidentally used extremely high radiation doses during CT stroke scans on over 200 patients, the risks of CT scanning have become a major concern. In the USA alone, CT is thought to be responsible for about 6,000 additional cancers a year.

Retained devices and un-retrieved fragments

Another frequent source of reports to ECRI and the US FDA are foreign bodies left inside patients following treatments. These take the form of retained devices, where an entire device is unknowingly left behind, and un-retrieved device fragments in which a portion of a device breaks away and remains inside the patient. While often benign, if a patient later undergoes magnetic resonance examination, retained metal can heat or migrate resulting in burns or worse.

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