Desperately ill patients died alone in hospitals, tended in their final hours by burnt-out health workers.  An avalanche of misinformation undermined care, and non-COVID patients and programmes faced cancelled appointments and treatment delays.

These are some of the factors that undermined patient safety during COVID-19, according to a rapid review by the World Health Organization (WHO), published on Tuesday.

Dr Francesco Venneri, an Italian emergency surgeon who worked in COVID-19 hospital care in Florence, described the stress of treating so many patients at the launch of the review.

“The pandemic was a sort of tsunami in Italy. Being on the front line, what I experienced was the stress on healthcare workers trying to follow all the patients.

“There were so many patients who flowed into the hospital with acute conditions. Many of our emergency departments overflowed, and sometimes to treat acute patients was very difficult,” said Venneri, who advocated for hospitals to conduct simulation exercises to address catastrophes.

He also said health workers were overwhelmed by information about the virus.

“One of the most important pitfalls is the mass of information that they came to us, and some of this information was contradicted immediately, a few minutes or a few hours afterwards. So we were very, very confused and this influenced many medical decisions and many nursing conditions,” said Venneri.

Family members excluded

“We heard many harrowing reports of family members being excluded from physical contact with a loved one who was seriously ill or even dying. Of course, this was all in the interest of trying to control the spread of the infection, but it seemed almost to squeeze out the compassion in care,” said Sir Liam Donaldson, WHO Envoy for patient safety.

Australian patient advocate Stefanie Newell agreed, describing the presence of a patient’s family member or friend as something that should be a “non-negotiable norm” in hospital policy.

She warned against “prioritising infection control over all other risk factors”, stressing that the presence of a family member or patient care partner help to minimise adverse events for patients.

“Exclusion of the personal team member of the patient has led not only to distress but certainly poorer outcomes for people,” said Newell.

“We need to think about the health system including those critical people as part of the clinical team because to exclude them creates a major issue not only for the patient but also for staff because that communication link has gone,” said Newell, who is a founding member of the Australian chapter of the WHO Patients for Patient Safety programme.

Misinformation

Baylor College of Medicine’s Dr Hardeep Singh, who was assisted with the review, said that a “big surprise was the amount that misinformation really impacted patient safety”.

“The impact of misinformation has really, really been brought out by the pandemic. We had some of this going on even before the pandemic, but what we noticed was adverse events that were happening because of misinformation, and this was a global phenomenon,” said Singh, who heads health policy quality and informatics at the US-based college.
“This is going to be a problem for decades to come.”

However, Singh also said that a “lot was unknown” about the impact of COVID-19 on patient safety as there was a lack of information about adverse events during COVID-19.

Donaldson also highlighted disruptions to essential childhood immunisation programmes around the world, in part because “the staff involved in those programmes were repurposed to treat and diagnose patients with COVID”.
“The consequence of course was that for all the childhood immunisation programmes, there was an estimated loss of at least a year, particularly in low-income countries.”

Singh added that care disruptions included the postponement of elective surgeries, while “many patients with advanced cancers could not get care for months”.

Neelam Dhingra, WHO unit head of patient safety, said that the review “explored the impacts of the COVID 19 pandemic on patient safety in terms of the risks and avoidable harm, specifically in terms of diagnostic, treatment and care management related issues”.

The review was commissioned by the Federal Office of Public Health Switzerland in preparation for the fifth ministerial summit on patient safety, which will take place in Switzerland in February 2023.

Image Credits: Credit: Press Information Bureau (PIB), Wikimedia Commons/Amarvudol.