AJR: Metrics + motivation sets stage for improved rad safety

Radiology departments must define and monitor their safety metrics to measure departmental performance, identify problem areas and track improvement, while also fostering a supportive department culture, according to an article published in the February issue of the American Journal of Roentgenology.

“The goal should not be regulatory compliance but rather the development of a just culture in which every employee works daily toward establishing a safe patient experience and reports problems without fear of reprisal,” wrote C. Daniel Johnson, MD, of the Mayo Clinic in Scottsdale, Ariz., and colleagues. “This culture of safety looks beyond individual errors to identify processes and systems for lasting improvement.”

The motivation for maintaining a safe radiology department is threefold, with moral, professional and business perspectives, according to the authors. Additionally, regulatory agencies such as the Joint Commission set goals for patient safety, and the article pointed out numerous safety processes and related metrics that are relevant to radiology, including:

• Timely reporting of critical tests: These are tests that are so critical that a phone or face-to-face report is required within a predetermined time, according to the authors. They offered a CT exam of the head with the indication “stroke alert” as an example of a critical test, and said these sorts of critical findings must be communicated directly to the ordering physician within 60 minutes of the request.
• Hand hygiene: Appropriate hand hygiene is performed both before and after contact with patients and requires at least 15 seconds of washing with an alcohol-based cleaner. This is to be conducted regardless of whether gloves are worn. Measuring hygiene metrics can be done through direct observation audits, patient surveys or quantities of hand cleanser used.
• Preventing unnecessary procedures: Following standard protocol by labeling studies with correct patient information and left/right markers, then double checking this information, can prevent unnecessary imaging, according to the authors.
• Medication reconciliation: A patient’s current medications should be checked to ensure that any combination with medication used in the radiology department will not result in adverse effects. Patient allergies should be considered.

Johnson et al noted that the examples don’t include radiation dose measures, which have attracted public and industry scrutiny and are also important.

“The principle of ALARA (as low as reasonably achievable) is well known and is now accepted as standard practice in radiology, as is the more recent Image Gently program for pediatric patients,” wrote the authors. “Both strive to deliver the lowest dose possible to create diagnostic-quality images.” In addition to dose awareness campaigns, the authors said CT reconstruction algorithms can reduce radiation dose and most imaging equipment that uses ionizing radiation now includes dose per exam reports to monitor radiation.

A department can set these and other safety goals, but tracking compliance with these measures only matters when that information is analyzed and applied to improving practice.

“The more specifically the measures can be related to individual work areas, the more effective is the improvement,” wrote the authors. “Regular feedback of the data needs to be provided to the individuals performing the work with knowledge of the goals, the reasons for their importance and their current state. This iterative feedback to the front line is critical for behaviors to change significantly.”

This feedback doesn’t have to take a reproachful tone. All errors should be reported, and employees should feel safe in reporting them, so that an accurate picture of departmental safety can be seen and allow problem areas to be identified before a patient is harmed.

“Fundamental to a good safety event reporting system is a blame-free culture that recognizes that humans are fallible and that processes and systems of care can be modified to reduce errors and improve operational safety.”