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.

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.

Quality improvement initiative to reduce serious safety events and improve patient safety culture.

BACKGROUND AND OBJECTIVE: Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital. METHODS: A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture. RESULTS: SSEs per 10000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P < .0001). The days between SSEs increased from a mean of 19.4 at baseline to 55.2 (P < .0001). After a worsening of patient safety culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009. CONCLUSIONS: Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions.