Patient safety in radiology. Risk and preventive factors in the radiography process

Abstract

The radiology department plays an important part in health care. The purpose of radiology is to diagnose (or exclude) and follow up health conditions and treatments, and to be used in interventional treatments, through the utilization of radiographic imaging techniques. The pace of technological developments in the field is constantly accelerating and risk for patient safety incidents can exist in every phase of a radiological examination. Measures and understanding to improve patient safety in radiology are important and could have a great effect for patient safety work. The overall aim of this thesis was to identify potential risk and preventive factors in radiology. The data collection consisted of 17 individual interviews with radiographers (study I and II), self-reported Swedish Hospital Survey on Patient Safety Culture (S-HSOPSC) questionnaires completed by 171 radiographers (study III), and 923 risk events drawn from patient safety reporting systems (PSRSs) (study IV). The data were analysed using largely qualitative methods including content analysis and thematic analysis, both inductive and deductive, but also using descriptive statistics. The analysis yielded six risk areas in radiology, based on numerous descriptions of patient safety incidents. Several success factors contributing to patient safety were described, as well as strengths and weaknesses in safety dimensions. The results of the thesis show that all activities in radiology are closely interconnected, interacting in a complex way, and further, that risk and harm are not exclusively caused by activities within the radiology department. There must be awareness that long-term effects of events can occur and are not always related to activities performed in radiology. Preventive factors such as good referrals, teamwork, standardized methods, expertise knowledge and a good patient safety culture have been identified in the thesis. The radiographer has a central role in patient safety work and has good knowledge of risks and preventive factors. Through the radiographer’s ability to detect risks in time, many patient safety incidents can be prevented, and patient suffering avoided. Furthermore, there are many activities in connection with the radiological examination that are not always “known” but that involve external actors in the radiography process. Therefore, the radiological practice and its expertise needs to be visible, with collaboration across the process.