JACR: Radiology falls short on national safety reporting
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Previously, the aviation and nuclear power industries have paved the way with the development of national incident reporting systems. Anesthesiology was the first medical specialty to embrace incident reporting as part of a comprehensive quality improvement strategy.
Radiology can learn from the success of these models, according to Jason N. Itri, MD, PhD, from the department of radiology at University of Pennsylvania Hospital in Philadelphia, and Arun Krishnaraj, MD, MPH, from the department of radiology at Massachusetts General Hospital in Boston.
The aviation industry launched the Aviation Safety Reporting System (ASRS) in 1976, and “it is widely credited for substantially improving safety by using [incident] reports to redesign aircrafts, air traffic control systems, airports and pilot training to reduce human error.” The system employs confidential reporting of incidents and strong feedback mechanisms.
The American Society of Anesthesiology developed the Anesthesia Patient Safety Foundation (APSF) in 1985. It uses feedback mechanisms similar to ASRS, which have led to a 10- to 20-fold reduction in mortality and catastrophic morbidity, according to the foundation. APSF also uses critical incident reporting systems to guide improvements in the technical and nontechnical aspects of anesthesia practice and training, wrote Itri and Krishnaraj.
The development of incident reporting systems in radiology has proceeded at at a slower pace. A voluntary program spearheaded by the American College of Radiology (ACR) has not yet garnered strong engagement.
The authors noted that effective incident reporting is based on several key strategies, including:
- Involving stakeholders in the design and testing of the reporting system;
- Confidential rather than anonymous reporting to enable follow-up and ensure accountability;
- De-identification of reported data; and
- Encouraging multiple stakeholders to report near misses and adverse events.
The combined use of structured data, which feeds systems analysis to identify causes, and narrative, which offers a more complete perspective than data alone, is essential, offered Itri and Krishnaraj. They also noted the need for timely feedback to reporters and key players.
Despite the benefits of incident reporting, deploying a system in healthcare is challenging, as the profession is characterized by a culture of blame and reporters fear legal action, financial penalties, disciplinary action and other barriers. “Considerable effort must be made to shift from a culture of blame to a culture of safety,” wrote Itri and Krishnaraj.
Finally, the authors detailed barriers to participation in the ACR’s National General Radiology Improvement Database (GRID), which collects information on incident reports. Since its launch in January 2009, GRID has enrolled 36 facilities, with 20 providing data in the January to June 2011 reporting period.
There are three primary barriers to more robust participation in GRID, according to Paul Larson, MD, chair of the ACR’s quality and safety commission: suboptimal data collection tools, lack of anonymity due to limited participation and lack of awareness.
“Ultimately, radiologists need to feel compelled to participate in incident reporting registries because of their inherent value in improving both individual practices and the profession as a whole,” concluded Itri and Krishnaraj. Such systems can improve the healthcare system and help mitigate the impacts of patient safety errors.