Improving patient safety in radiology.

OBJECTIVE: Both horizontally oriented interventions (aimed at improving culture and environment in an effort to reduce the number of human errors potentially leading to patient harm) and vertically oriented (aimed at a specific area of errors) are needed to create a comprehensive safety program in radiology. Our objective is to describe horizontal interventions introduced to improve safety in radiology. CONCLUSION: Horizontal interventions--such as operational rounds with radiology leadership, safety coach programs, error prevention training, and a lessons-learned communication program--can successfully improve the safety culture and performance in radiology.

Quality initiatives: department scorecard: a tool to help drive imaging care delivery performance.

The radiology department at a midwestern U.S. children's hospital has created a scorecard that is presented quarterly to the institutional leadership and is available to all radiology employees on the institutional intranet. The scorecard currently has 33 measures in six areas: clinical services (safety, quality, timeliness); education; research; professionalism, communication, and user satisfaction; finances and administration; and staffing. For each measure, the goal, current value of the measure, interval at which the measure is updated, date of last update, and previous value of the measure are listed. Each measure was reviewed over time to determine those measures for which target goals were met. Results indicate that a visible and transparent department scorecard is one of the more powerful tools available to the radiology leadership to call attention to and improve performance in specific areas. The use of such a scorecard can help develop a departmental culture of quality improvement, focus healthcare providers on specific quality improvement projects, and drive departmental performance.

Safety coaches in radiology: decreasing human error and minimizing patient harm.

Successful programs to improve patient safety require a component aimed at improving safety culture and environment, resulting in a reduced number of human errors that could lead to patient harm. Safety coaching provides peer accountability. It involves observing for safety behaviors and use of error prevention techniques and provides immediate feedback. For more than a decade, behavior-based safety coaching has been a successful strategy for reducing error within the context of occupational safety in industry. We describe the use of safety coaches in radiology. Safety coaches are an important component of our comprehensive patient safety program.

Improving patient safety in radiology: concepts for a comprehensive patient safety program.

A comprehensive safety program can have a positive influence on safety performance and safety culture within a department of radiology. The program should include both vertical interventions aimed at specific areas of potential safety errors as well as horizontal interventions aimed at improving safety culture and decreasing the baseline rate of human error. In our opinion, the key cultural transformations that must occur to improve safety culture include recognition that safety is an issue, emphasis that everyone is accountable for patient safety, and creating a culture where people are expected and encouraged to speak up in the face of uncertainty. The article describes the horizontal interventions to improve patient safety used in our department.

Improving patient safety: effects of a safety program on performance and culture in a department of radiology.

OBJECTIVE: Emphasis is being placed on improving the safety performance of the health care delivery system. The purpose of this study was to evaluate the effects of a program on safety performance and culture in a pediatric radiology department. MATERIALS AND METHODS: A comprehensive safety program implemented in a department of radiology included error prevention training for all employees, a safety coach program, safety awards, Crucial Conversations training, and operational rounds with radiology leaders. The number of serious safety events (events with deviation from best practice, patient harm, and causation) that in part involved radiology were compared for 2 years after implementation of the program and the previous 2 years (baseline). A U.S. Agency for Healthcare Research and Quality safety culture survey was distributed to radiology employees, and the responses were compared for periods early in the program and after full implementation of the program. Fisher's exact test was used to evaluate for statistically significant differences (p < 0.05) in the survey responses and the frequency of serious safety events. RESULTS: Before introduction of the safety program, radiology contributed to a serious safety event an average of once every 200 days as opposed to once in 780 days after implementation of the program (one event in more than two academic years) (p = 0.37). Improvement was found in all 12 dimensions of the culture survey after implementation of the program. Radiology scored higher than hospital averages in 10 of 12 dimensions of the survey. CONCLUSION: The safety program had a positive effect on safety culture. Although it is early in the process and proving statistical significance for rare events such as serious safety events is difficult, the mean number of days between serious safety events has increased from 200 to 780. We conclude that the program is having a positive effect on safety performance.

Frequency and Severity of Acute Allergic-Like Reactions to Intravenously Administered Gadolinium-Based Contrast Media in Children.

OBJECTIVES: The purpose of this study is to determine the frequency and severity of acute allergic-like reactions to gadolinium-based contrast media (GBCM) in children before, during, and after the transition from gadopentetate dimeglumine to gadoterate meglumine as our primary clinical GBCM. MATERIALS AND METHODS: Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective investigation. Allergic-like reactions to GBCM in pediatric patients were retrospectively assessed from January 2009 to January 2017, which included a departmental change of GBCM from gadopentetate dimeglumine to gadoterate meglumine. Allergic-like reactions were identified from departmental and hospital databases. The number of doses of GBCM was obtained from billing data. Allergic-like reaction frequencies for each GBCM were calculated and compared using the chi-squared test. RESULTS: A total of 32,365 administrations of GBCM occurred during the study period (327 for gadofosveset trisodium; 672 for gadoxetate disodium; 12,012 for gadoterate meglumine; and 19,354 for gadopentetate dimeglumine). Allergic-like reactions occurred after 21 (0.06%) administrations. Reaction frequencies were not significantly different among the GBCM (0.3% gadofosveset trisodium; 0% gadoxetate disodium, 0.06% gadoterate meglumine, 0.08% gadopentetate dimeglumine; P > 0.05). Ten (47.6%) reactions were mild, 10 (47.6%) were moderate, and 1 (4.8%) was severe. The overall reaction frequency peaked during the 6-month transition period from gadopentetate dimeglumine to gadoterate meglumine (0.20%), compared with 0.07% pretransition (P = 0.048) and 0.04% posttransition (P = 0.0095). CONCLUSION: Allergic-like reactions to GBCM in children are rare. Gadoterate meglumine has a reaction frequency that does not significantly differ from other GBCMs. During the transition from gadopentetate dimeglumine to gadoterate meglumine, an increase in the frequency of reported allergic-like reactions was observed, likely reflective of the Weber effect.

IRQN award paper: Operational rounds: a practical administrative process to improve safety and clinical services in radiology.

As part of a patient safety program in the authors' department of radiology, operational rounds have been instituted. This process consists of radiology leaders' visiting imaging divisions at the site of imaging and discussing frontline employees' concerns about patient safety, the quality of care, and patient and family satisfaction. Operational rounds are executed at a time to optimize the number of attendees. Minutes that describe the issues identified, persons responsible for improvement, and updated improvement plan status are available to employees online. Via this process, multiple patient safety and other issues have been identified and remedied. The authors believe that the process has improved patient safety, the quality of care, and the efficiency of operations. Since the inception of the safety program, the mean number of days between serious safety events involving radiology has doubled. The authors review the background around such walk rounds, describe their particular program, and give multiple illustrative examples of issues identified and improvement plans put in place.