Safety hazards in radiology departments likely to originate during early treatment

Reporting safety concerns in radiology is a practice that’s been growing in the U.S. alongside increasing awareness of incident learning systems. It’s also one that’s prompting physicians to look into where—and how often—safety hazards are appearing in daily practice.

Lead author Jean L. Wright, MD, and colleagues in Johns Hopkins’ radiation oncology department explored the trend at their own facility, where they analyzed an in-house incident learning system (ILS) that’s been in use for more than two years.

“Radiation oncology departments have increasingly adopted the use of ILS into their safety and quality programs, and the recently developed ASTRO Accreditation Program for Excellence standards identify having a system for reporting and tracking events as a basic element of a quality radiation oncology department,” Wright and her team wrote in Practical Radiation Oncology. “Despite this, the optimal approach to utilizing and learning from ILS remains unclear.”

Johns Hopkins’ current ILS is based around its 2011 base model, which racked up 193 event reports in its first year of use. Since, the system has expanded to serve five regional clinical sites and has been optimized to categorize events by type, origin and method of discovery. For study purposes, events were also assigned Risk Priority Numbers (RPNs) based on the Failure Modes Effect and Analysis (FMEA) model and a score on the near-miss risk index (NMRI).

In its first full year of the system’s update, 1,351 safety events were reported across five locations, according to the authors. 

“Our long-term goal is to determine whether the FMEA model will be useful in identifying mechanisms to reduce future risk by applying scores to events which have already occurred, and in prioritizing responses to events based on these scores,” Write et al. wrote. “We also aim to compare the utility and feasibility of the RPN to the NMRI.”

Observing both workflow and near-miss events during 2016, the team found that more than 96 percent of events were workflow-related, while near-miss events—or those thought to have the potential to reach a patient—made up just 3.8 percent of the pool. On a scale of 1 to 10, occurrence of workflow events averaged a 6.14.

Workflow events were significantly more likely than their near-miss counterparts to both originate and be detected in the treatment phase, Wright and colleagues said. But the most common point of origin for the two was the first phase in the process map—or the patient assessment phase.

“Patient assessment is a phase during which a great deal of documentation, preparation and communication is necessary to initiate the planning process, and thus it is logical that many events would originate here,” they wrote. “Events originating in later phases of the process map generally had lower frequency, higher severity and poorer detectability.”

The fact that the majority of workflow and near-miss events fell into the same small group of common categories means targeted interventions to prevent safety hazards could work well, the researchers said. The more technical aspects of the ISL trial, like RPN measurements, could be useful for identifying specific remedies for individual situations.

“Our experience with high-volume ILS in a large regional radiation oncology department suggests a potential utility of the RPN scoring system to guide mitigation strategies for both workflow and near-miss safety events that goes beyond the utility of the less-detailed NMRI,” Wright et al. said. “Our experience also highlights the critical relationship between the safety and clinic operational teams, and the need for these teams to work collaboratively to maximize the potential of a departmental ILS.”