Hospital injuries to patients and health care workers rose significantly during pandemic

A new report from the Mass. Department of Public Health found steep increases in assaults on health care workers, as well as suicides and falls among patients.

An ambulance passed a sign alerting drivers, that due to the COVID-19 pandemic, no visitors were allowed at Beverly Hospital in Beverly, Mass., April 23, 2020. The amount of misery and abuse suffered by hospital patients, and the workers who cared for them, jumped significantly during the pandemic, new data show.Charles Krupa/Associated Press

The amount of misery and abuse suffered by hospital patients, and the workers who cared for them, jumped significantly during the COVID-19 pandemic, new data from the Massachusetts health department show.

From patients who developed severely damaged skin, known as pressure ulcers, which often appear while bed-ridden for hours without being moved, to caregivers and security officers being assaulted by patients, the numbers paint a sobering picture of the heavy toll exacted by the pandemic on the state’s health care system and the people in it.

“I have been practicing for 40 years, and I never thought I would see pressure ulcers in the emergency department because people are in the department so long,” said Dr. Gregory Volturo, chair of emergency medicine at UMass Memorial Health and a member of the state’s Public Health Council, a panel of academics and clinicians that helps set policy for the state health department.

The findings, presented to the panel Wednesday, summarize so-called serious reportable events, which are incidents that result in harm and are considered to be largely preventable.

The report found that the number of serious reportable events at acute care hospitals rose more than 50 percent from 2018 through 2022, from 1,066 to 1,632.

Among the most eye-opening increases were suicides and serious injuries among patients who cut themselves, ingested objects, overdosed on medications, or hung themselves. Most of these events, the report said, occurred in adults aged 26-65 but one-third were among adolescents, aged 12-19.

There were 36 such incidents in 2018. That soared to 68 last year.

Similarly, the report counted 80 physical assault or abuse incidents in 2022, up from 45 in 2018.

The report noted that over half of the physical assaults or abuse events that resulted in serious injury were by patients on clinical staff, security officers, paramedics, and EMTs, often resulting in lost work.

“Many of the findings in this report are a direct consequence of chronic, longstanding understaffing of registered nurses by hospitals, which force nurses to care for too many patients at one time,” the Massachusetts Nurses Association said in a statement.

A recent association survey of nurses found many who said the quality of care at hospitals has deteriorated as their colleagues burned out and left for less stressful jobs. Those who remained said they didn’t have enough time to give their patients the care and attention they needed and were forced to care for too many patients at one time.

The association’s survey found that one in four nurses reported not feeling safe in their workplace, and 70 percent said they had encountered at least one instance of workplace violence or abuse in the past two years.

Barbara Fain, executive director of the Betsy Lehman Center for Patient Safety, said the state’s new data are frustrating but not surprising. She said the pandemic has worsened many areas of patient safety, with higher rates of health care-associated infections, falls, and pressure ulcers.

“There is national data showing a big increase in infections, so a lot of the gains we saw in the years leading up to the pandemic have been eroded,” Fain said.

She also noted that the state’s data only reflect incidents in places that are tracking such events. There are several settings, such as physicians’ offices, that do not collect safety data.

“Some hospitals are better than others in detecting safety events and reporting safety events, so the results are only a small fraction of preventable harm events,” she said.

Fain said the dramatic increase in serious events such as falls and pressure sores are a “strong signal” of what happens when there aren’t enough staff to respond quickly, for instance, when a patient presses a nurse call button seeking help to go to the bathroom, gets frustrated with a long wait and tries to walk by themselves, and falls.

“This is the reality we are in, a situation of scarcity, and longer term we have to think about how do we get out of this situation,” she said.

The state’s report found the number of patient pressure sores increased nearly 70 percent from 2018 through 2022, with 664 reported last year.

Pressure sores often are found on elderly patients whose skin has thinned, making them more vulnerable to such ulcers. But Katherine Fillo, deputy director for clinical and health care systems quality in the state’s Bureau of Health Care Safety and Quality, said that wasn’t necessarily the case in the state’s findings.

Instead, she said, hospital patients in their 50s and 60s were reported to have bed sores.

Volturo, the UMass Memorial emergency department chief, said he is concerned that bed sores and other preventable incidents across the state may worsen in the fall unless staffing significantly improves.

“We are in the spring and summer months and we will get through it,” he said. “But in the fall ... we often can’t accept patients from our own community because we are full. They sit in the hallways, and this is the result you are seeing.”