COVID-19, Human Factors and Patient Safety in Long-Term Care Facilities

In response to COVID-19, healthcare workers (HCWs), other employees and volunteers in the healthcare industry are facing a number of unexpected challenges such as: increased workload, higher throughput of medical screenings, reallocating personnel, cross-training personnel in new departments, expediting testing procedures, and donning/doffing personal protective equipment more frequently. This is compounded in long-term care facilities where staffing shortages and high turnover, high resident‐to‐staff ratios, supply shortages and inadequate infection prevention and control measures have been well-documented for years preceding the advent of COVID-19.

 

Healthcare provision in any of today’s medical, or sociotechnical, settings is complex.  This complexity is a function of the interaction of workplace psychosocial factors, standards of care, organizational processes and procedures, patient throughput, patient-to-provider ratios, evolving technology and ergonomics (e.g., physical workspace/medical device design).  Further, HCWs are faced with balancing the demands of ethical patient care with the legal and economics-based demands of organizations where they are employed.  Adverse outcomes related to healthcare provision result from both active (e.g., HCW error) and latent factors (e.g., inadequate procedures) that emerge from this complexity. With respect to healthcare acquired infections (HCAI), undesired outcomes are formulaic of ‘perfect storms’ in environments where breaches in organizational defenses facilitate the spread of microbes to those most vulnerable.  The consequences of adverse outcomes can be devastating, including the unnecessary loss of life, as demonstrated by the toll that coronavirus has recently taken in long-term care facilities for the elderly.

Human Factors (HF) has a demonstrated utility in improving patient safety and in diminishing the adverse effects of HCAIs specifically.  HF professionals are currently conducting research in areas directly related to COVID-19.  Such efforts are aimed at immediate response, as well as at preparation for and response to future public health threats. HF professionals who engage in such work seek to enhance HCW and organizational performance as well as to protect HCWs, patients and their family members as well as the general population. The value of HF is clear in identifying, investigating and preventing HCAIs, and more broadly, medical error and malpractice. There is a growing trend in applying HF expertise to improving medical systems performance, a much needed and overdue approach to preserving patient safety and reducing both patient harm and the unnecessary loss of life.

 

By Philip Fatolitis, Ph.D.

 

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