Medical Imaging Risk Management

Information and communication can contain losses and improve patient safety in Radiology, Imaging Centers and Primary Care:

According to information posted on their McKesson’s Website: (McKession Consulting, Pharmaceutical Distribution and Technology Solutions) through a blog written by  Dr. Jonathan B. Kruskal, the importance of Radiology Information Systems is making medicine safer for the thousands of patients requiring MRI services throughout the country.   These findings and reportings by McKesson echo a common theme by the Risk Management, Patient Safety Foundation that is often published by The Doctors’ Company; that conclusion, that basic theme of patient safety calls for better communication and immediate study of the cause of errors.

Dr. Kruskal believes that Radiology Information Systems can improve outcomes and reduce patient injuries.  It is important to communicate abnormal results and begin immediate follow up to abnormal results: Radiology Information Systems, when implemented properly, can be used to

Just as in the field of pathology, false positives and analytical errors, it is important to turn each error into a learning experience.

Internal Medicine Claims analysis: Missed Diagnoses and other medical errors are common:  The Doctors’ Company’s David Troxel reported on his findings of a study of Internal Medicine Claims:  Dr. David Troxel’s examination of internal medicine claims in “An Analysis of Internal Medicine Malpractice Claims” provides valuable information about medical errors, system failures, and high-risk clinical events that contribute to adverse patient outcomes.  These findings and the conclusions of many risk management studies like the one published by McKesson referenced above study the following categories (usually involving patient populations of 500 – 1,500);

TDC’s study found that the percentage of claims were in the following areas:


Patient Assessment


Selection and Management of Therapy (57% were medication-related)


Communication with Patient/Family


Patient Factors


Communication Among Providers


Documentation/Medical Record


Patient Monitoring


Failure/Delay in Obtaining Consult/Referral



More than half of the patient safety/risk management issues in the Patient Assessment category studied by Dr. Troxel were linked to allegations of missed or delayed diagnosis—: failure or delay in ordering a diagnostic test, failure to establish a differential diagnosis, and a missing or inadequate clinical information assessment.    Studying these errors in Radiology, Internal Medicine, Pathology; learning about the systemic causes of errors will help to build a better medical system throughout:  Error detection systems are essential in order to manage errors, minimize the degree of harm, manage the contributing factors, science, equipment and personnel involved.

Strategies for Comprehensive Performance Improvement:

Dr. Kruskal, talking to McKesson HealthCare Consultants again references the work that it is doing, through a publication called  “Strategies for Establishing a Comprehensive Quality and Performance Improvement Program in a Radiology Department,” The reporting system is as follows:

  • web-based patient safety reporting system
  • mandatory peer-review process where each physician is expected to peer-review at least 5% of his or her prior year’s volumes
  • an intradepartmental web-based reporting system..

The reporting of errors must be actively discussed amongst all hospital personnel.   After the report of Radiological, Imaging errors, All errors undergo the basic cause analysis, seeking to identify the root cause of the error.

An example of an imaging center error analysis might involve many people: the schedulers, office staff, technologists, sonographers, nurses, radiology fellow and radiology attending. The patient must also be considered to identify any potential patient factors that may have contributed to the error in question.

Technology improves Healthcare by encouraging more analysis:

Technology will add automated, routine reporting of errors, throughout the healthcare delivery system, resulting in an immediate shift in culture and improved interdepartmental articulation, resulting in fewer errors overall.

New trainees, nurses, residents and fellows will be required to take courses in the software programs requiring the entry of data, of error information, known causes and contra indications so this is part of the culture from the beginning of their career and working experience in the hospital and medical group system.

In addition, the ability of RIS to allow peer-review, easy, manageable reporting of all events will facilitate this improvement. By requiring immediate reporting of errors, When a study is ordered, the ordering physician is fully aware of what prior studies have been performed and what the patient’s prior radiation exposure has been and the reactions to those exposures is contained within the document. 

Continuing the theme of communication in prevention of errors:

Finally,, these are some tips that were documented by Dr. Troxel in his study of over 600 claims in Internal Medicine.

These tips can improve and organize the communication :

  • Identify the physician (hospitalist or specialist) who is in charge of the care of the patient, and make sure everyone is informed.
  • Familiarize yourself with hospital policies and protocols governing the roles and responsibilities of all physicians, including specialists, consultants, and hospitalists.
  • Make sure there is verbal communication between physicians when the care of a patient is being handed off so they can determine each physician’s responsibilities. The staff should have a clear understanding of which physician is in charge of the patient’s care.
  • Utilize a standardized communication process such as SBAR (Situation Background Assessment Recommendation) during patient handoffs. Find out if your hospital has such a policy.
  • Make sure all clinicians caring for the patient review the patient’s histories and physicals, daily physician notes, and nursing assessments. The physician in charge of the patient’s care is responsible for reviewing the medical record and for ensuring that appropriate orders are written and carried out.
  • Take action when you perceive there is a delay in implementing an order.
  • Take steps to transfer the patient to another physician if you are concerned that he or she is not communicating with you or the staff and, therefore, is not involved in or is not capable of being involved in treatment.



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