R.I. hospital interventional radiology dept put on probation
The interventional radiology department of Kent Hospital in Warwick, R.I., has been put on probation for at least six months due to pervasive problems identified by the Rhode Island Department of Health (HEALTH). Also, each of Kent's interventional radiologists is being referred to the Board of Medical Licensure and Discipline to determine if any disciplinary action should be taken.
On June 19, Kent notified HEALTH that a wrong-site procedure had taken place in the interventional radiology department. A patient had a long-term IV catheter inserted into the incorrect arm. During HEALTH's on-site inspection, Kent reported a second case where a patient had x-ray contrast injected into the wrong hip.
HEALTH discovered several problems in the hospital's interventional radiology department, including failure to follow established hospital time out procedures for six out of eight cases reviewed, radiology equipment that had not been inspected or had out-of-date inspections and unqualified staff using radiology equipment. A detailed description of the findings from the inspection can be found in the deficiency report.
"With the recent state-wide focus of preventing medical errors in hospital operating rooms, this is particularly concerning," said David R. Gifford, MD, R.I. director of health. "While we determined this issue is isolated to the interventional radiology department, the fact that the efforts in the operating room were not being adopted in the interventional radiology department is unacceptable."
The hospital signed a consent agreement to resolve the issues that includes the following provisions:
Additional conditions are described in the full consent order.
On June 19, Kent notified HEALTH that a wrong-site procedure had taken place in the interventional radiology department. A patient had a long-term IV catheter inserted into the incorrect arm. During HEALTH's on-site inspection, Kent reported a second case where a patient had x-ray contrast injected into the wrong hip.
HEALTH discovered several problems in the hospital's interventional radiology department, including failure to follow established hospital time out procedures for six out of eight cases reviewed, radiology equipment that had not been inspected or had out-of-date inspections and unqualified staff using radiology equipment. A detailed description of the findings from the inspection can be found in the deficiency report.
"With the recent state-wide focus of preventing medical errors in hospital operating rooms, this is particularly concerning," said David R. Gifford, MD, R.I. director of health. "While we determined this issue is isolated to the interventional radiology department, the fact that the efforts in the operating room were not being adopted in the interventional radiology department is unacceptable."
The hospital signed a consent agreement to resolve the issues that includes the following provisions:
- Kent will hire a consultant to evaluate interventional radiology policies and protocols for compliance with national best practices and then report to HEALTH on their recommendations.
- It will observe and monitor the interventional radiology department and submit monthly reports to HEALTH for six months.
- Kent will contract with a patient safety organization.
- It will provide continuing education for the radiology staff and develop an education plan for any newly hired radiology staff in the future.
- Kent will provide proof of up-to-date inspections for all radiology equipment within two weeks.
Additional conditions are described in the full consent order.