Patient Safety: On the Radar?

Patient safety is a constant priority in healthcare, though the areas of emphasis are ever-shifting. Currently, radiation exposure risks dominate radiology headlines, and for good reason. But what other patient safety concerns fly under the radar? Below are five patient safety issues that might not attract as much attention in the medical literature, but nevertheless remain imperative for patient safety.


1. Radiation dose backlash

Advanced imaging use has exploded. CT use nearly tripled between 1996 and 2010, and average per capita effective dose rose from 1.2 mSv in 1996 to 2.3 mSv in 2010, according to a study published June 12 in the Journal of American Medical Association. Providers and vendors have taken notice, and lowering dose has become a ubiquitous goal. Still, there are aspects of this hot button issue that remain under the radar.

As more stories are written about the effects of radiation from medical imaging, public perception could shift to overestimate these risks, creating a new patient safety issue. Exposure to ionizing radiation should be taken very seriously, but dose fears, if not kept in context, could lead some patients to refuse imaging services that could benefit them.

“We are now in a sort of backlash situation where patients are afraid of tests like CT scans because they’re scared of radiation,” says Roy L. Gordon, MD, associate chair for safety for the department of radiology and biomedical imaging at the University of California, San Francisco. Although there has been an increase in radiation exposure, he says the benefits of medical imaging in aiding diagnosis far outweigh the risks.

Gordon suggests a three-pronged dose initiative. First, physicians need to ask whether an imaging test needs to be ordered at all. Second, doses for individual scans should be lowered as much as possible, with protocols adjusted so that only as much dose to gather the needed information is used. Finally, if a diagnostic imaging exam is clinically indicated, physicians must allay patient fears so he or she doesn’t forgo the scan.

2. Wrong site, wrong procedure, wrong patient imaging

Performing a medical procedure on the wrong patient or on the wrong site in a correctly identified patient is a nightmare scenario for a provider. Conventional wisdom pegs surgery as the prime culprit for such errors. However, they may be more prevalent in radiology than commonly assumed, according to the Pennsylvania Patient Safety Authority (PPSA). In 2009, the PPSA received reports of 652 “wrong events” in radiology statewide, half of which were wrong procedure and 30 percent of which involved a radiologic study performed on the wrong patient.

The PPSA recommends applying the Universal Protocol for surgical procedures to procedures performed within radiology, says Lea Anne Gardner, PhD, RN, senior patient safety analyst for the organization.

“The Universal Protocol identifies steps healthcare clinicians can implement to prevent wrong site, wrong procedure, wrong person surgery, which is outlined by the Joint Commission, but these principles can be applied to other areas.”
Some guidelines from the Universal Protocol easily adaptable to radiology include: marking the site and side of proposed procedures; performing a pre-procedure time-out to verify the nature of the procedure once the patient is on the exam table; and use of a time-out to ensure proper patient identification is entered into imaging systems.

3. Falls

Another focus area for the PPSA is prevention of falls during radiological procedures. Gardner explains that radiology has a higher percentage of falls that result in serious injuries than all other departments, mostly resulting in fractures, lacerations and head trauma. In 2009, 8 percent of all serious events reported in radiology departments were related to falls, according to the PPSA.

“Patients with a previous fall are at a much higher risk of falling. Older patients who fall are at a higher risk for injury,” says Gardner. When determining the type of transport needed to get a patient in position for an exam—whether it’s in an ambulatory or inpatient setting—extra assistance should be provided to obese patients, those in an altered mental state, patients prone to syncope or seizures and any other patients who might have their movement restricted for any reason.

4. MRI burns

The strong magnetic forces of an MRI scanner bring unique patient safety challenges, but at the 40th annual meeting of AHRA: the Association for Medical Imaging Management, Robert Junk, president of RAD-Planning in Kansas City, Mo., explained that the most discussed issues are not the ones that result in the most injuries.

“A lot of attention gets focused on implants, so you would think that implants are the biggest issue when it comes to MRI safety. It’s not even close,” explained Junk.

The most common causes of MRI injuries are burns when conductive materials become heated and touch the patient, according to Junk. Burns account for 69 percent of all MRI accidents, while implant issues cause just 2 percent of MRI injuries.

To prevent burns, Junk advised maintaining 1 cm of air gap or padding between patients and active radiofrequency elements, removing unnecessary items from around the patient that could conduct radiofrequency energy, and making sure any objects or leads that remain are properly insulated.

5. Critical results reporting

Timely reporting of critical results has been an area of emphasis for the Joint Commission since 2004 when National Patient Safety Goal 02.03.01 required important test results to be provided on time to the correct staff person.

When implementing a critical results reporting process, the Joint Commission advises that policies should be clearly defined and outlined, with specific procedures developed for abnormal test results and fail-safe communication methods. All involved staff should understand their responsibilities.

Focus on safety

Staffing decisions made by some organizations demonstrate the heightened emphasis on patient safety, says Gordon. “Our department and other departments across the U.S. have taken the unusual step of appointing safety officers within radiology, which recognizes the importance of the topic.”

Whether or not a hospital or radiology group has a dedicated safety officer, implementing effective patient safety strategies requires planning and foresight. Departments should meet regularly, consult relevant guidelines from professional societies and safety organizations and make sure that all safety concerns—from dose reduction to proper patient identification—are properly accounted for and addressed.