By Marianne Matthews
In a rapidly changing healthcare system with mounting government mandates, today’s providers must keep pace with an enormous amount of new developments. That fact was evident in the plethora of information offered—on a wide array of subjects—by experts and exhibitors alike at the Association for Medical Imaging Management (AHRA) conference earlier this month.
Patient safety was one key topic that kept resurfacing both in educational sessions and on the exhibit floor.
Quality and Safety Rules
It was standing room only at Teri Yates’ session on “Risk Management in Radiology.” Over 100 people packed in to hear her talk, which was designed to help radiology administrators identify and mitigate the major sources of liability in their department. Yates, founder and owner of consulting firm, Accountable Radiology Advisors, emphasized a key message: That radiology administrators must make it their business to be aware of all potential sources of liability in the department— whether or not they can mitigate those risks personally, or collaborate with other departments to do so.
Yates pointed out that radiology is a high-risk department, and in fact, radiology is the sixth highest risk specialty out of 28. It’s no wonder then that her audience remained highly engaged during the 90-minute session in an un-air-conditioned room! In a clear and compelling manner, Yates explained how providers can address key risks, which fall into three major categories—safety, quality, and compliance.
A valuable takeaway from her presentation had to do with the critical role culture plays in mitigating risks. “If people are not comfortable reporting a problem or an error, you can’t fix it,” said Yates. She then presented some recent data that indicates that far too many healthcare workers are concerned they will “get in trouble” if they report a mistake. More than 500,000 staffers representing over 1,100 hospitals were surveyed for a report called “Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report.” An unfortunate finding: The majority of respondents including physicians feel that their mistakes are held against them.
Yates encouraged her audience to build what she called “a just culture.” That is to say, “an atmosphere of trust in which people are encouraged (even rewarded) for providing essential safety-related information, but in which they are also clear about where the line must be drawn between acceptable and unacceptable behavior.” In short, a climate of openness coupled with accountability can put radiology providers on the right path to mitigating risk.
Getting Dose Wise
AHRA 2014 also offered attendees ample ways to learn about conquering the challenges surrounding radiation dose. While I could hardly attend them all, there appeared to be countless educational sessions on dose.
For example, there was “Radiation Dose Management—Deciphering the Puzzle,” which focused specifically on CT. Several attendees told me they planned to attend the Sectra-sponsored “7 Requirements for an Enterprise Patient Radiation Safety Program,” which was led by Ascendian Healthcare Consulting. Chris Tomlinson of The Children’s Hospital of Philadelphia also teamed up with Ascendian to lead a breakout session titled “An Executive Guide to Implementing a Successful Dose Solution,” which aimed to cover the legislation and regulation surrounding radiation dose recording and reporting.
Dose was even addressed in an off-beat session that I thoroughly enjoyed called “Patient Care Over There: What We Can Learn from Radiology Practices Around the Globe.” In this interesting and entertaining session, Todd Minnigh of Carestream took his audience on a trip around the world; a “road show,” if you will—complete with his own kind of wacky travel slideshow (just like you’d expect from an American!). His message: Looking beyond our borders can help us find out-of-the-box solutions for so many of our challenges in healthcare.
“Most of Europe is very dose conscious,” said Minnigh. “In Germany, for example, radiation dose is very carefully managed. This is one reason portables are limited in the emergency department. Scatter reaches other patients even though they may be ‘far away’ by our way of thinking.” In German EDs, they simply skip the chest x-rays, but the ED is equipped with a CT scanner if the patient needs it. “They see this process as part of their dose management program,” said Minnigh. He also noted that in Germany, every machine has a Dose Area Product Meter (DAP) right on the collimator to determine the amount of radiation the machine produced. Carefully tracking dose is a common practice in Europe, and Minnigh believes US providers can learn a thing or two about it from our foreign friends.
Clearly, radiology administrators at AHRA were hungry for accurate information about dose, clarity on regulatory issues, and solutions for tracking and managing dose.
That curiosity was also welcomed in the exhibit hall, where manufacturers were ready and willing to share dose solutions with providers. Several digital radiography vendors were talking up their dose management tools including Agfa Healthcare. During AHRA, Loma Linda University Medical Center (LLUMC) announced that the hospital is completing its upgrade to direct radiography (DR) through Agfa’s Digital Radiography Upgrade Program. The unique cost structure allows the hospital to transition its CR technologies to DR without a major capital investment—in fact, it will “pay for itself,” according to Roland Rhynus, executive director of the radiology department at LLUMC.
But Rhynus said that good pricing was only one incentive for moving forward with Agfa. “The primary reason for making the transition from CR had to do with dose,” said Rhynus. “We are regularly seeing a 30% dose reduction since we converted to DR.” The institution began the transitioning process in October 2013. Ultimately, LLUMC’s Digital Radiography Upgrade Program will include the installation of 11 Agfa DX-D retrofit systems to convert existing CR-based radiography rooms to digital systems, and five wireless DX-D 100 mobile DR systems.
“Our Pediatric Radiology Chair was really pleased with this move to DR,” said Rhynus. “The exams are easier on our patients, and the lower dose is so important. It’s really good for our NICU, too.”
When it comes to dose management, Rhynus pointed out the value of education. “We have our on-site physicist involved [in the DR transition project]. He regularly and repeatedly reminds our technologists to keep dose down, to avoid dose creep.” What’s more, Agfa Healthcare is playing a role in the education process, too. Rhynus said the company plans to conduct two 4-hour ASRT-certified continuing education sessions on dose reduction for LLUMC staffers.
For providers who were seeking to educate themselves on patient safety in radiology—be it risk management and compliance, MRI matters, or radiation dose monitoring—it’s a safe bet they found it all at AHRA 2014.