Health Equity: A National Safety Patient Goal

Health equity will officially become a National Patient Safety Goal on July 1, 2023.

On that date, the Joint Commission’s Leadership Standard LD.04.03.08 will be elevated to a new National Patient Safety Goal, Goal 16: Improve healthcare equity.

The move is intended to encourage hospitals to view healthcare disparities as a quality and safety priority – and to nudge them to address healthcare inequities and improve patient safety.

Age, Race and Gender Increase Risk of Adverse Events

A 2020 study published in the International Journal of Equity in Health noted that “An emerging body of research indicates that patients from minority groups are at higher risk of patient safety events.” The authors of the study conducted a systematic review of 45 research studies and found that in the United States:

• African-Americans have 1.25 to more than 1.5 times the rate of infections, post-operative sepsis, pressure injuries, post-operative respiratory failure, and post-operative pulmonary embolism or deep vein thrombosis than white Americans, even when controlling for income level.
• Hispanics have 1.25 to 1.5 times the rate of sepsis as white Americans.
• Asian/Pacific Islanders have 1.25 to 1.5 times the rate of sepsis, hemorrhage or hematoma, and respiratory failure as white Americans.

Interestingly, a Dutch study did not note any differences in rates of adverse healthcare events for patients of different ethnic groups – a finding the authors surmise may be explained by the availability of “equal access to care” under a national health system.

Other research has found that Medicare patients (who are all age 65 or older) have a 1 in 4 chance of experiencing injury, harm, or death when admitted to a hospital, compared to a 1 in 10 chance for patients of all ages. Women are 50% more likely than men to be misdiagnosed when having a heart attack, and 25% more likely to be misdiagnosed after a stroke. Maternal mortality rates for Black  women in the United States are three times higher than for white women. And Black, Latinx, Asian, and Indigenous people experience higher rates of healthcare-associated infections (HAIs) than white people in the U.S.

Targeted Interventions Key to Improving Health Equity & Patient Safety

In a report announcing the elevation of health equity to a National Patient Safety Goal, the Joint Commission wrote, “Although healthcare disparities are often viewed through the lens of social injustice, they are first and foremost a quality of care problem. Like medication errors, healthcare-acquired infections, and falls, health care disparities must be examined, the root causes understood, and the causes addressed in order to improve health care equity.”

To improve health equity, hospitals must first identify disparities and determine contributory and causative factors. Data can help hospitals effectively uncover these issues. Monitoring hand hygiene and nurse rounding can help hospitals detect patterns that may affect HAI rates and patient falls, for instance. If the data reveals that nursing staff consistently visit certain patient rooms less frequently than others, nursing and hospital leadership may need to dig a bit deeper to determine the reasons for that disparity. (Perhaps some rooms are simply located too far from the nursing station? If so, establishing a secondary nursing station may help.)

The researchers who conducted the 2020 International Journal of Equity in Health review noted that healthcare professionals often use patient relatives as interpreters when patients and providers speak different languages – and that the use of family members as interpreters can increase the patient safety risk. Consistently using professional interpreting services (which are free in most places) may improve patient safety and equity.

Innovative Technologies Can Help

Some research suggests that technology can help clinicians address healthcare inequities. A 2021 article in Current Infectious Diseases Report said that “uptake of innovative technologies may assist in mitigating HAI inequities,” noting that a rural health system that implemented an electronic hand hygiene system experienced significant improvement of hand hygiene within six months and “concomitant significant reduction in HAIs.”

Technology that tracks nurse rounding and bedside report may also help health systems initiate and sustain evidence-based nursing practices known to increase patient safety.

With determination and data, hospitals can improve healthcare equity.