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Risk management in radiology departments

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MINIREVIEWS

Risk management in radiology departments

Horea Craciun, Kshitij Mankad, Jeremy Lynch

Horea Craciun, University Hospitals of Morecambe Bay NHS result of technology breakthroughs, rise in workload,
Trust, LA1 4RP Lancaster, United Kingdom deficit in workforce and globalization. Risk is considered
Kshitij Mankad, Great Ormond Street Hospital for Children to be the chance or possibility of incurring loss or of
NHS Trust, WC1N 3JH London, United Kingdom a negative event happening that may cause injury to
Jeremy Lynch, Chelsea Westminster Hospital NHS Trust, SW10
patients or medical practitioners. There are various
9NH London, United Kingdom
causes of risks leading to harm and injury in radiology
Author contributions: Craciun H generated the paper concepts departments, and it is one of the objectives of this
and design, completed the literature review and wrote the paper to scrutinize some of the causes. This will drive
manuscript; Mankad K and Lynch J contributed to the writing of to consideration of some of the approaches that are
the manuscript and to its preparation and editing. used in managing risks in radiology. This paper aims
at investigating risk management in radiology, and this
Conflict-of-interest: I wish to confirm that there are no known will be achieved through a thorough assessment of the
conflicts of interest associated with this publication and there has risk control measures that are used in the radiology
been no significant financial support for this work that could have department. It has been observed that the major
influenced its outcome.
focus of risk management in such medical setting is
Open-Access: This article is an open-access article which was to reduce and eliminate harm and injury to patients
selected by an in-house editor and fully peer-reviewed by external through integration of various medical precautions. The
reviewers. It is distributed in accordance with the Creative field of Radiology is rapidly evolving due to technology
Commons Attribution Non Commercial (CC BY-NC 4.0) license, advances and the globalization of healthcare. This
which permits others to distribute, remix, adapt, build upon this ongoing development will have a great impact on the
work non-commercially, and license their derivative works on level of quality of care and service delivery. Thus, risk
different terms, provided the original work is properly cited and management in radiology is essential in protecting the
the use is non-commercial. See: http://creativecommons.org/ patients, radiologists, and the medical organization in
licenses/by-nc/4.0/
terms of capital and widening of the reputation of the
medical organization with the patients.
Correspondence to: Dr. Horea Craciun, University Hospitals
of Morecambe Bay NHS Trust, 414 Mill View House, Aalborg
Place, LA1 4RP Lancaster, Key words: Risk management; Radiology; Patient safety
United Kingdom. [email protected]
Telephone: +44-7463-460219 © The Author(s) 2015. Published by Baishideng Publishing
Group Inc. All rights reserved.
Received: January 6, 2015
Peer-review started: January 7, 2015 Core tip: This paper serves as a review of risk manage­
First decision: March 6, 2015 ment in radiology. It investigates the potential sources
Revised: April 20, 2015
of risk within radiology departments and proposes
Accepted: May 5, 2015
Article in press: May 6, 2015
measures that may potentially mitigate these risks.
Published online: June 28, 2015 A major focus of risk management is to reduce harm
and injury to patients and personnel and it aims to
improve the outcomes from radiology departments.
Risk management in radiology is essential in protecting
the patients, radiologists, and the medical organization.
Abstract
Medical imaging and interventional radiology sustained
prompt changes in the last few years, mainly as a Craciun H, Mankad K, Lynch J. Risk management in radiology

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 Craciun H et al . Risk management in radiology departments

departments. World J Radiol 2015; 7(6): 134-138 Available from: should be put in place to pave the way for higher
URL: http://www.wjgnet.com/1949-8470/full/v7/i6/134.htm DOI: standards of care. Quality systems are effective risk
http://dx.doi.org/10.4329/wjr.v7.i6.134 control measures, hence the importance of professional
organisations to lead, establish, uphold and improve
[8]
them . Quality improvement measures range from
quality maps, measurable metrics and performance
INTRODUCTION indicators to audits and accreditation programmes.
These collective efforts may decrease a department’s
Medical imaging and interventional radiology have [9]
risk and benefit patients .
sustained dramatic changes in the last few years, mainly
Risk management in radiology is primarily developed
as a result of technological breakthroughs, the rise in
and fostered to help safeguard patients, working
workload, a deficit in the workforce and globalisation.
personnel and the entire organisation. Protection of
Consequently there is an expanding concern about
the organisation is largely grasped in terms of finance
standards of care, maintaining patient safety and the
management and potential drawbacks linked to
management of risk in radiology. [10]
unreliable results that could damage its reputation .
People understand the concepts of risk and risk
Managers and clinicians in the radiology department
management in a medical setting in different ways. Risk
should focus on improving the general quality of care
is considered to be the possibility of incurring loss or
medical staff deliver to patients. Radiology professionals
of a negative event occurring that may cause injury to
[1] subject themselves to risk every time they perform a
patients or medical practitioners . One cannot predict
procedure because some of the techniques and instru­
all risks. That is to say, injury to patients may occur even [11]
ments they use in scanning and imaging are complex .
in the best hospitals where patients receive high-quality
Thus, players in the healthcare setting must work
services and treatments. Then risk management refers
carefully and diligently to ensure that they minimise
to the various approaches that medical practitioners
[2]
health risk to patients and to themselves. In practice,
and professionals integrate to reduce risk . This is inherent hazards to safety and quality manifest in
a proactive concept that involves practices such as relation to personnel availability, workload and financial
identification of risk, quantification and evaluation of predicaments. They consist of insubstantial funding for
risk and consideration of measures that can be used to new equipment in the workplace, difficulty retaining
eliminate or control risk in a medical setting. All those professionals, the escalating complexity of the work, the
involved in providing healthcare services participate in increasing workload, difficulty recruiting due to a national
risk management. This includes management of the shortage of medical staff and the lessening budget that is
medical centres obligated to provide adequate facilities, not keeping up with current of demands.
staff, resources, financial support and equipment, thus Radiology professionals must persuade administrators
helping professionals and nursing practitioners reduce and managers that standards of care relate closely to
[3]
the odds of harm’s occurring . performance metrics like workload, diagnostic precision
This paper aims at investigating risk management [12]
and patient safety concerns . Thus, managers must
in radiology through a thorough assessment of the make sensible decisions about resource allocation and
risk control measures that are used in the radiology performance expectations to mirror this reality and curtail
[4]
department . The major focus of risk management in [10]
risks .
such medical settings is to reduce and eliminate harm All health professionals must identify some of the
and injury to patients through the incorporation of issues that tend to cause harm to patients in advance
[5]
various medical precautions . As depicted in Figure 1 and work on them before subjecting the patient to
risks leading to harm and injury in radiology departments [13]
potentially faulty processes . The concept of ALARP, or
stem from various causes. One objective of this paper “as low as reasonably practicable”, essentially refers to
is to scrutinise some of these. This will expand into the the assessment of risk, and the comparison of this risk
consideration of some of the approaches healthcare with the amount of time, money and resources needed
practitioners implement to manage risk in radiology. to address it. It is used throughout the healthcare system
and is particularly important when it comes to radiology.
When assessing whether a risk is ALARP, it is essential to
RISK MANAGEMENT compare the measures being proposed with those that
Safeguarding patients and personnel would normally be used, also known as “good practice”.
The rapid expansion of services, the globalization of Good practice is decided upon after detailed discussion
healthcare and the imbalance between workload and with stakeholders. However, good practice is not always
workforce are a few of the factors that may threaten the enough, and if an issue is particularly complicated, or if
[6]
standards of health services as well as patient safety . no good practice has yet been formulated for the issue,
There is a rising demand for radiologists and for 24/7 it is often necessary to revert back to the “first principle”.
services. Therefore, international teleradiology is leading In sum, ALARP is about calculating the amount of risk
[7]
the globalisation occurring in the field of radiology . attached to measures, and assessing how difficult, in
To meet the expectations of quality services, systems terms of resources, controlling this risk is. It offers those

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 Craciun H et al . Risk management in radiology departments

Risk management in radiology - summary

Quality systems Transparency

Workforce
Quality maps Error disclosure
Measurable metrics Malpractice
Safeguard litigation
Performance indicators
Discrepancy
Audits Patients meetings

Accreditation
programmes Personnel

Recruiting
The organisation Strategies

Workload
Proficiency and expertise Protocols

Professional Evidence based

competence guidelines
Equipment
Peer review
Financial management activites
Funding

Figure 1 Summary of control measures in risk management in radiology.

[22,23]
who use it a great deal of flexibility, as it involves the care, employ prudence when using devices off label ,
setting of goals, thus allowing room to manoeuvre if improve communication skills with colleagues and
[24]
necessary. patients and obtain professional liability insurance.
Risk management allows radiologists to focus on Stakeholders, including radiologists, must possess
measures for reducing potential risk. This ensures that competence and significant knowledge and skills in
medical staff follow appropriate and relevant protocols working with all the implements within the radiology de­
[14] [25]
and guidelines to reduce risk in radiology departments . partment as a way of reducing the number of errors .
Every radiologist should be conscious of error sources,
Error disclosure and malpractice litigation particularly those typically constituting origins of
[26]
Recent studies on malpractice suits
[15]
revealed that litigation . Medical staff must unveil and emphasise
[27]
amongst the most frequent causes of legal claims against error pitfalls to prevent the recurrence of inaccuracies .
radiology professionals were: diagnostic errors followed In the future, various factors will shape radiological
by procedural complications, poor communication malpractice: the emergence of new imaging techniques,
with the referring doctor and poor physician-patient innovation in image processing, new protocols scientific
[16]
rapport . Risk management is a crucial instrument in societies publish and guidelines professional organisations
[28]
preventing and limiting adverse events and errors in delineate . To minimise risk, medical staff should
medical settings .
[17]
cultivate a safety culture in every radiology department
The most common medical errors encountered in and perceive feedback on a possible error as a learning
[29]
malpractice suits are vascular injuries and complications experience . The radiologists and other key players in
after needle biopsies in interventional radiology ,
[18]
the department need to understand that their practice
missed or delayed cancer diagnosis especially in imaging and performance significantly contribute to the trust
[30]
of the breast
[19]
and missing diagnosis in skeletal patients place in them . Radiologists need to provide
[17]
radiology . A major objective in risk management good standards of practice and care and show respect for
[31]
is the reduction of litigation and the associated costs. a patient .
The magnitude of these costs should suffice to argue Disclosing radiological errors to patients stands out
that avoiding the problems that may cause lawsuits as the most demanding challenge a radiologist may
[20]
positively impacts the patients and radiologists . encounter. With a misguided error disclosure approach,
The reduction of errors in a radiology department radiologists risk not meeting professional norms in
[32]
is attainable if all parties in the department are aware addition to creating erratic and unsafe practice patterns .
of and up to date with all the methods and protocols Failure to acknowledge responsibility and achieve
[21]
involved in risk reduction . transparency around errors subverts patient safety.
One can manage litigation risk in a radiology Despite this, risk management concerns about litigation
department through a number of approaches. Healthcare have long precluded the endorsement of standards
professionals should set up and follow high standards of around error disclosure. More recently, risk managers

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 Craciun H et al . Risk management in radiology departments

[42]
have emphasised that clear disclosure after radiological errors and near misses is crucial . Discrepancy
errors is crucial to risk management and can reduce meetings are invaluable in medical practice and offer the
[33]
exposure to liability . opportunity to assess current practice and highlight areas
[11]
that might need improvement . The Royal College of
Professional competence and equipment Radiologists recommends that all radiologists attend
Medical practitioners in the department must ensure discrepancy meetings and morbidity and mortality
that they keep their knowledge and skills updated. To meetings. Evidence of attendance may be required
achieve competencies and proficiency in their areas of to support the revalidation process, so doctors should
[43]
expertise, radiologists must perform their duties within carry out personal reflections . Inappropriate conduct,
the limits of their understanding and competence .
[34] such as unethical handling of a patient’s records and
This allows them to do what they understand best, thus intentional carelessness, is a contributing factor to
reducing the probability of causing danger, harm or injury errors. However, medical staff can mitigate this factor
[8]
to patients . The requirement is closely related to the through adherence to department and/or organisational
[39]
recommendation that the radiologists need to maintain procedures and protocols .
high trust and confidentiality with their clients through the
[35]
establishment of a professional relationship . Moreover,
CONCLUSION
workers attain competence in a medical setting if they
comprehend and appreciate the benefits of collaborating The field of radiology is rapidly evolving due to tech­
[36]
with other professionals in their field . This implies that nological advances and the globalisation of healthcare.
to reduce risk in radiology departments, doctors need to This ongoing development greatly affects the quality
work as a team, combine their knowledge and skills and, of care and service delivery. Doctors and professional
more importantly, share their experience as a way of organisations should display initiative and oversee and
promoting excellence in their field .
[37] tackle challenging conditions in an effective manner to
Modern radiology is greatly reliant on the application safeguard patient safety and standards of care. The
of state-of-the-art diagnostic and therapeutic devices, quality of a radiological report relies on the various
but such state-of-the-art technology carries risk. To important steps outlined above. The essence of risk
avoid the risk associated with the use of faulty devices management is to survey all potential reasons for an
inaccurate report in advance so that procedures can
in the radiology sector, quality assurance departments
be put in place to prevent them. More importantly, the
must be diligent in ensuring that all the equipment used
[38] medical organisation offering radiology services needs
is in good condition and of high quality .
to allow innovation and responsive measures that can
Risk management relating to the use of therapeutic
improve radiology. Thus, risk management in radiology
devices requires all professionals to possess sufficient
is essential in protecting the patients, radiologists and
knowledge, skills and technical ability to operate the
medical organisation (i.e., protecting the organisation’s
devices, recognise when they break down and identify
capital and its reputation with patients).
inaccurate results.
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