Weak patient identification policies and inadequate behavioral health training for staff are leading to dangerous yet preventable errors at American hospitals, according to patient safety advocates.

The ECRI Institute, a Philadelphia-based not-for-profit that evaluates medical equipment, released its annual list of top 10 patient safety concerns for healthcare organizations on Monday. The group called for improved patient identification to prevent dangerous errors as well as training for staff who are forced to deal with behavioral issues in non-behavioral-health settings, among other issues.

ECRI is a federally listed patient safety organization charged with collecting and analyzing reports of patient safety events at its member hospitals. Hospitals with over 50 beds are required by law to engage with a patient safety organization or implement an evidence-based safety initiative.

The not-for-profit has received over 7,600 reports related to errors in identification or data, roughly 9% of which have resulted in patient harm, including two deaths. These errors include omitting drug allergies, giving a patient the wrong drugs or dosage or even performing the wrong surgery on a patient.

Healthcare organizations can use technology to prevent some of these errors, such as scanning of drugs and patient wristbands, simplifying patient identification documents or including photos in the electronic health record, said William Marella, executive director of ECRI’s patient safety organization operations and analytics,

Including patient photos in EHRs could also improve efficiency and accuracy, as humans process faces faster than text, Marella said. Even though most of the major EHR systems support the input of patient photos, only 20% of hospitals use this feature, according to ECRI.

Some of the most important fixes to patient identification errors involve little-to-no technology, like training providers not to refer to patients by their room number, which can change during their hospital stay, Marella said. Ultimately, providers need to develop a culture where patient identification is important and clinicians don’t become lax about following important policies.

ECRI’s list also called on providers to enact policies around de-escalating behavioral health situations in non-psychiatric areas of their hospital. This recommendation follows calls by several organizations and government agencies for healthcare workers to receive better protection and training to prevent workplace violence, which is sometimes caused by mentally unstable patients.

In most hospitals, patients admitted to non-psychiatric units aren’t formally assessed for their likelihood to be violent or aggressive, even though they may have underlying psychiatric issues that aren’t disclosed, said Nancy Napolitano, an ECRI patient safety analyst. That can leave staff unprepared if the patient becomes unstable.

On the other hand, staff who are aware of a patient’s violent tendencies but aren’t properly trained to deal with them may avoid the patient because they’re scared of being harmed. That can result in lapses or delays in patient care, which can make the patient even more upset.

“When you fear something that you don’t know, you tend to want to stay away from it,” Napolitano said. “These patients’ needs aren’t being addressed and that can cause aggression.”

Medical staff who are focused on treating a patient’s physical ailments also often stop administering their patient’s psychiatric medication, either intentionally or by mistake, which can cause drastic changes in behavior.

Hospitals need to provide training to all staff on how to de-escalate situations involving mentally unstable patients, Napolitano said. Some hospitals have created 24/7 behavioral health emergency response teams made up of specially-trained doctors and nurses who can respond to situations that might require advanced intervention.

Even if a hospital doesn’t have a psychiatric unit, they still need to be prepared to deal with mentally-ill patients, Napolitano said, much like a hospital without a trauma center is still expected to be able to stabilize a trauma patient that may come in their doors.

“Our healthcare industry is very reactive to violence as opposed to being proactive,” Napolitano said. “You can expect violence, but you don’t have to tolerate it.”