Using near-miss events to improve MRI safety in a large academic centre

Radiographer training for screening of patients referred for Magnetic Resonance Imaging: A scoping review

INTRODUCTION

Strict safety practices are essential to ensure the safety of patients and staff in Magnetic Resonance Imaging (MRI). Training regarding the fundamentals of MRI safety is well-established and commonly agreed upon. However, more complex aspect of screening patients, such as image review or screening of unconscious patients/patients with communication difficulties is less well discussed. The current UK and USA guidelines do not suggest the use of communication training for MRI staff nor indicate any training to encourage reviewing images in the screening process. This review aims to map the current guidance regarding safety and patient screening training for MRI diagnostic and therapeutic radiographers.

METHODS

A systematic search of PubMed, Trip Medical database and Radiography journal was conducted. Studies were chosen based on the review objectives and pre-determined inclusion/exclusion criteria using the PRISMA-ScR framework.

RESULTS

Twenty-four studies were included in the review, which identified some key concepts including MRI safety training and delivery methods, screening and communication, screening of unconscious or non-ambulatory patients and the use of imaging.

CONCLUSION

Training gaps lie within the more complex elements of screening such as the inclusiveness of question phrasing, particularly to the neurodivergent population, how we teach radiographers to screen unconscious/unresponsive patients and using imaging to detect implants.

IMPLICATIONS FOR PRACTICE

The consequences of incomplete or inaccurate pre-MRI safety screening could be the introduction of unexpected implants into the scanner or forgoing MRI for a less desirable modality. The development of enhanced training programs in implant recognition using imaging and communication could complement existing training.

Identifying a list of healthcare 'never events' to effect system change: a systematic review and narrative synthesis

BACKGROUND

Never events (NEs) are patient safety incidents that are preventable and so serious they should never happen. To reduce NEs, several frameworks have been introduced over the past two decades; however, NEs and their harms continue to occur. These frameworks have varying events, terminology and preventability, which hinders collaboration. This systematic review aims to identify the most serious and preventable events for targeted improvement efforts by answering the following questions: Which patient safety events are most frequently classified as never events? Which ones are most commonly described as entirely preventable?

METHODS

For this narrative synthesis systematic review we searched Medline, Embase, PsycINFO, Cochrane Central and CINAHL for articles published from 1 January 2001 to 27 October 2021. We included papers of any study design or article type (excluding press releases/announcements) that listed NEs or an existing NE framework.

RESULTS

Our analyses included 367 reports identifying 125 unique NEs. Those most frequently reported were surgery on the wrong body part, wrong surgical procedure, unintentionally retained foreign objects and surgery on the wrong patient. Researchers classified 19.4% of NEs as 'wholly preventable'. Those most included in this category were surgery on the wrong body part or patient, wrong surgical procedure, improper administration of a potassium-containing solution and wrong-route administration of medication (excluding chemotherapy).

CONCLUSIONS

To improve collaboration and facilitate learning from errors, we need a single list that focuses on the most preventable and serious NEs. Our review shows that surgery on the wrong body part or patient, or the wrong surgical procedure best meet these criteria.

The Value of Learning From Near Misses to Improve Patient Safety: A Scoping Review

OBJECTIVES

For years, health care has recognized that learning from near misses offers potential opportunities to reduce unintended harm to patients. However, these benefits have yet to be realized. It is assumed that effective actions are being implemented as a result of learning from healthcare near misses, leading to improvements in patient safety. A scoping review of the healthcare literature was undertaken to explore the value of learning from near misses in the improvement of patient safety.

METHODS

The scoping review was conducted on Ovid MEDLINE, Embase, and CINAHL. Eligible articles published since 2000 were included.

RESULTS

A total of 4745 articles were identified through the searches, with 19 included in the final review. The articles included one randomized control trial. All the included articles had evidence of action after reporting or investigation of near misses, with the majority showing evaluation of impact. Actions were human, administrative, and engineering focused. Impact evaluation focused on the reduction of near misses, but without consideration of patient safety outcome measures, such as harm. The review also noted limited availability of experimental research and variability in near-miss definitions and that actions are not just the result of near misses.

CONCLUSIONS

Currently, health care assumes that reporting and learning from near misses improves patient safety. The literature provides limited evidence supporting these assumptions and shows that actions as a result of near misses are commonly aimed at the human. There is a need to prove the benefits of focusing on near misses in health care and for more system-level actions.

MRI Safety Practice Observations in MRI Facilities Within the Kingdom of Jordan, Compared to the 2020 Manual on MR Safety of the American College of Radiology

Purpose

The absence of ionizing radiation in MRI applications does not guarantee absolute safety. Implementing of safety guidelines can ensure high-quality practice in the clinical MRI with the minimum risk. For this purpose, this cross-section quantitative study conducted in Jordan Kingdom aimed to assess current MRI safety guidelines in comparison with those of 2020 Manual on MR Safety of the American College of Radiology (ACR).

Patients and Methods

A site observation study of 38 MRI units was undertaken in June 2021. A well-structured MRI safety questionnaire was the primary data collection method. Data were subjected to a descriptive statistics content analysis by the SPSS version 20. The results were analyzed to yield comprehensive discussions.

Results

A total of 38 MRI facilities in participated in this study with the responding rate of 44.7%. Patient screening areas and changing rooms were available in about 29% (11/38) of the MRI facilities. Most facilities (55%, 21/38) conducted verbal screening only whereas 21% implemented both written and verbal screening for their patients and companions in zone II, which was present in a percentage of 29% in the approached facilities. Meanwhile, only 13 (43.2%) of 38 facilities used handheld magnets for physical screening, 25 (65.8%) of MRI units did not use any kind of ferromagnetic metal detection systems. Three (7.9%) participating centers had MR-safe wheelchairs, ventilators, anesthesia machines, and stretchers. Most MRI facilities participating in this study (71%) had emergency preparedness plans for alternative power outages. Despite a relatively low number of participating centers having an emergency exit or code (26.3% and 10.5%, respectively), none of them performed practice drills for such scenarios.

Conclusion

Investing in new MR-safe equipment requires introducing ferromagnetic detecting systems. More research is needed to establish the degree of MRI professional’s safety-related education.

MR- safety: Evaluation of compliance with screening routines using a structured screening interview

Background

Magnetic resonance (MR) safety procedures are designed to allow patients, research subjects and personnel to enter the MR-scanner room under controlled conditions and without the risk to be harmed during the examination. Ferromagnetic objects in the MR-environment or inside the human body represent the main safety risks potentially leading to human injuries. Screening for MR-safety risks with dedicated procedures is therefore mandatory. As human errors during the screening procedure might align and lead to an incident compliance is essential.

Purpose

To evaluate compliance with a documented structured MR-safety screening process.

Method

Written and signed MR-safety screening documentation collected at a national 7T MR facility during a four-year period was evaluated for compliance of trained personnel with multi-step MR-safety routines. We analysed whether examinations were performed or why they were not performed. Data analysis further included descriptive statistics of the study population (age, gender and patient or healthy volunteer status), identification of missing documents and omitted or incorrect answers, and whether these compliance shortcomings concerned predominantly administrative or MR-safety related issues.

Results

Documentation of the screening process in 1819 subjects was incomplete in 19% of subjects. The most common documentation shortcoming was omitted fields. Out of 478 omitted answer-fields in 307 subjects, 36% were of administrative nature and 64% related directly to MR-safety issues.

Conclusion

Compliance with MR-safety screening procedures cannot be taken for granted and deficiencies to comply with screening routines were revealed. Documentation shortcomings concerned both administrative and MR-safety related issues.

Using a resident-led patient safety quality council to educate future QI leaders

Resident-led councils represent an important initiative to involve trainees in patient safety, but little is known about how to create and sustain one of these councils. We evaluated the impact of a resident-led patient safety council in an internal medicine residency program. We assessed change in resident perception of safety issues over 3 years, scholarship activities, and behavioral choices to participate or lead patient safety activities after residency.The Stony Brook Internal Medicine Residency Program formed the Patient Safety and Quality Council (PSQC) in 2014, consisting of fifteen peer-nominated residents serving a three-year term. Surveys were distributed annually from 2014 to 2017 to measure resident council members' perception of patient safety. The number of safety-related abstract/publications were tracked during and one year after graduation. Additionally, graduates from the council were surveyed to assess the influence of the council on post residency involvement and leadership in safety activities.A total of 18 residents have participated in the council from 2014 to 2017. Overall, resident perception of safety culture improved. A total of 17/18 (94%) PSQC resident members demonstrated scholarship activities in safety during residency: 8/18 (44%) were engaged in an independent Quality Improvement (QI) project, 5/18 (27%) achieved a quality improvement leadership role post residency. A total of 15 of 18 (83%) recent graduates suggest that involvement with the safety council during residency fostered future involvement in patient safety.Implementation of a resident-led safety council can help to improve the safety culture, generate scholarly activities, and encourage continued participation in patient safety after graduation.

Comparing Artificial Intelligence Approaches to Retrieve Clinical Reports Documenting Implantable Devices Posing MRI Safety Risks

OBJECTIVE

Assess sensitivity, specificity, and accuracy of two approaches to identify patients with implantable devices that pose safety risks for MRI-an expert-derived approach and an ontology-derived natural language processing (NLP). Determine the proportion of clinical data that identify these implantable devices.

METHODS

This Institutional Review Board-approved retrospective study was performed at a 793-bed academic hospital. The expert-derived approach used an open-source software with a list of curated terms to query for implantable devices posing high safety risk ("MRI-Red") in patients undergoing MRI. The ontology-derived approach used an NLP system with terms mapped to Systematized Nomenclature of Medicine-Clinical Terms. Queries were performed in three clinical data types-25,000 radiology reports, 174,769 emergency department (ED) notes, and 41,085 other clinical reports (eg, cardiology, operating room, physician notes, radiology reports, pathology reports, patient letters). Sensitivity, specificity, and accuracy of both methods against manual review of a randomly sampled 465 reports were assessed and tested for significant differences between expert-derived and ontology-derived approaches using t test.

RESULTS

Accuracy, sensitivity, and specificity of expert-versus ontology-derived approaches were similar (0.83 versus 0.91, P = .080; 0.88 versus 0.96, P = .178; 0.82 versus 0.92, P = .110). The proportion of radiology reports, ED notes, and other clinical reports retrieved containing implantable devices with high safety risks for MRI ranged from 1.47% to 1.88%.

DISCUSSION

Artificial intelligence approaches such as expert-driven NLP and ontology-driven NLP have similar accuracy in identifying patients with implantable devices that pose high safety risks for MRI.