Australian sonographers’ perceptions of patient safety in ultrasound imaging: Part 1 – identifying the main safety concerns, a qualitative study

Abstract

Introduction: Patient safety has been an undervalued component of quality healthcare but is a challenging area of research. Ultrasound is the most common imaging modality in the world. Research on patient safety in ultrasound is generally focused on bioeffects and safe operation of ultrasound equipment. However, other safety issues exist in practice that warrant consideration. This paper forms the first part of a PhD study exploring patient safety in medical diagnostic ultrasound, beyond the notion of bioeffects. The ultimate aim of the study is to inform the final phase of the research study which will consider the next steps in improving the quality and safety of healthcare experienced by patients. Methods: A qualitative study using semi-structured, one-on-one interviews. A thematic analysis categorised data into codes and generated final themes. Results: A heterogeneous mix of 31 sonographers, who reflected the profile of the profession in Australia, were interviewed between September 2019 and January 2020. Seven themes emerged from the analysis. These were bioeffects, physical safety, workload, reporting, professionalism, intimate examinations and infection control. Conclusion: This study presents a comprehensive analysis of sonographers’ perceptions of patient safety in ultrasound imaging, not previously available in the literature. Consistent with the literature, patient safety in ultrasound tends to be viewed in technical terms through the potential for bioeffects of tissue damage or physical harm to the patient. However, other patient safety issues have emerged, and while not as well recognised, have the potential to negatively impact on patient safety.

Australian sonographers’ perceptions of patient safety in ultrasound imaging: Part two – translation into practice

“…Below is a précis of the methods employed in the study. 8 outlines in-depth the recruitment process, the development of the interview questions and the generation of the initial codes and themes.…”

“…4,5 Theme 2: physical safety Risk of physical harm to patients was the second most common patient safety concern; sonographers felt that additional people present during ultrasound examinations, especially children, increases the risk of physical harm. 8 Tension exists between the use of ultrasound as a diagnostic procedure and patients' expectations for a social experience, most obvious during obstetrical ultrasound examinations. 16,17 Managing these expectations plays an important part in patients' physical safety during ultrasound examinations, and distractions should be limited to avoid physical harm.…”

“…The number of ultrasound examinations performed across the world has risen substantially in the last 10 years, and this was reflected in our study. 8 According to those interviewed, increasing workloads mean reduced examination times: 'ask any sonographer, scan times are being cut' (PS10).…”

“…The two biggest concerns for patient safety with regard to professionalism were competence and Fitness to Practice (FtP). 8 The TPB explains that when resources or opportunities are inadequate, motivation towards positive behaviour across all three beliefs can suffer. This explained sonographers' response to the issues around competence and FtP.…”

“…Part one identified what sonographers believe are the most common patient safety risks during ultrasound imaging. 8 Part two of the study, reported here, analyses and describes sonographers’ responses in managing these risks, using the TPB to explain their actions in practice.…”