The End of the Public Health Emergency Refocuses the Urgency to Improve Healthcare Quality

On May 11, 2023, the Biden-Harris Administration announced an end to the COVID-19 public health emergency that has been in place for three years. While the Nation is still vigilant about COVID-19 to avoid resurges of the virus, we must now turn our attention to the ongoing healthcare issues facing our Nation.

Several signals indicate that progress has stalled or reversed due to the stresses that the COVID-19 pandemic put on our local healthcare delivery systems and their workforces. The Leapfrog Group’s spring 2023 Hospital Safety Grade, one of many indicators that measure healthcare quality, provides data that speak to recent trends.

First, some encouraging news: According to the Leapfrog report, Clostridioides difficile infection rates improved 15 percent when comparing the period immediately before the pandemic to rates in late 2021 and 2022. There was no change in surgical site infections following surgery. 

But during the same period, as healthcare delivery systems in our communities strained under the pressures of COVID-19—treating sick patients, administering life-saving vaccines, and responding to the pandemic’s unpredictable waves—other problems worsened. Rates increased for methicillin-resistant Staphylococcus aureus infections (37 percent), central-line associated bloodstream infections (60 percent), and catheter-associated urinary tract infections (19 percent).

This Leapfrog report is just the most recent signal that we must rededicate ourselves at all healthcare delivery and management levels to improve the safety of our patients and workforce. As I have pointed out in public presentations, an AHRQ data analysis¹ published in JAMA showed that the Nation made slow but steady progress on a few hospital-acquired infections before the pandemic, but has not demonstrated progress on most conditions we examined. 

Similarly, a team of researchers in Massachusetts recently published a study² in the New England Journal of Medicine that estimated 1 in 4 people hospitalized are at risk of a patient safety event. While these are reportable events, we can assume the risks are more widespread; safety events in many non-hospital settings are not captured in our Nation’s current surveillance system.

The decline in patient experience is equally alarming, as captured in Leapfrog’s communication measures. They report five measures: nurse communication, physician communication, staff responsiveness, communication about medicines, and discharge information. Nationally, these measures, on average, also declined compared to pre-pandemic times. The most significant declines were in communication about medicines (declined 4.28 percent) and staff responsiveness (declined 3.46 percent). Like every service industry, customer experience is everything in healthcare; it is the heart of the relationship between healthcare providers and their patients.

We have lots of work ahead of us as we rebuild our healthcare delivery systems to be more resilient to all types of hazards, such as the biological hazard we faced with COVID-19.  But, in many parts of our Nation this spring, we also face natural disasters such as flooding, mudslides, and tornadoes. To respond effectively to these emergencies, we must help our Federal and State partners build robust public health systems.  But we must also focus on building resilient local healthcare delivery systems and hospitals that provide the high-quality personal healthcare that the people of this Nation want and expect.

We must start rebuilding our healthcare delivery systems immediately, focusing on improving patient safety and workforce well-being in hospitals and nursing homes. The goal should be to ensure healthcare safety within the next five years.  But we must quickly expand our quality improvement efforts in all settings where people seek and receive care, because healthcare is not of high quality unless it is high quality for everyone in our Nation.

Department of Health and Human Services (HHS) Secretary Xavier Becerra has recommitted HHS to improve healthcare quality in the United States. I urge you to join the National Action Alliance to Advance Patient Safety to learn about best practices, share resources and insights, and gain access to various AHRQ tools that help advance patient safety. Additionally, please sign up for the Action Alliance listserv to stay abreast of the latest news. Together we can provide safe, high-quality, and appropriate healthcare for all.

Dr. Valdez is Director of AHRQ.

1. Eldridge N, Wang Y, Metersky M, et al. Trends in adverse event rates in hospitalized patients. JAMA 2022 Jul 12;328(2):173-83. PMID: 35819424.
2. Bates DW, Levine DM, Salmasian H, et al. The safety of inpatient health care. N Engl J Med 2023 Jan 12;388(2):142-53. PMID: 36630622.

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