Clinical Risk Management in radiology. Part I: general background and types of error and their prevention

Golfieri, Rita; Pescarini, Luigi; Fileni, Adriano; Silverio, R; Saccavini, Claudio; Visconti, D; Morana, Giovanni; Centonze, Maurizio

doi:10.1007/s11547-010-0578-0

Cited by 10 publications

(3 citation statements)

References 36 publications

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“…Perception errors may be due to human fallibility, and can be explained by external factors (excessive time load and inappropriate workplace), technical mistakes, presence of abnormalities that were not under investigation, and by different lesions found in the same exam. On the other hand, interpretation errors may be influenced by inexperience, insufficient knowledge, or underestimation of radiographic signs that could lead to the correct diagnosis 5,29 .…”

Section: Discussionmentioning

confidence: 99%

Civil liability related to imaging exams in Brazil

Fontana¹,

Liedke²,

Fontoura³

et al. 2015

Braz. J. Oral Sci.

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Aim: To analyze all court lawsuits in Brazil in relation to civil liability involving radiographic and tomographic images up to February 2014. Methods: All Brazilian courts were surveyed for "civil liability," "error," "radiology," "radiography," and "tomography," returning 3923 second-instance lawsuits. Out of them were excluded labor legislation, health insurance coverage of radiological examinations, and criminal liability cases and 359 were selected. Compliance with expert reports, involvement of imaging exams, the defendant professional, the reasons of claims and convictions, and indemnity were evaluated. Results: Of the 359 selected lawsuits, physicians were defendants in 71%, radiologist physicians in 10.6% and dentists in 18.4%. The prevalence of physicians found liable was related to the lack or delay in requesting the imaging exams (49.6%), and among radiologist physicians, misdiagnosis (47.1%). Considering the dentists, imaging exams had mostly an indirect involvement, and failure of the proposed treatment (73.8%) was the most prevalent cause of dentists found liable; no radiologist was sued. Regarding indemnity, 50% of lawsuits resulted in compensation up to R$ 20,000 (US$ 8,583). Conclusions: Misdiagnosis was the main cause of claims and radiologists were found liable. The medical field showed the largest absolute number of claims and physicians were found liable, but the highest proportion was directed to dentists.

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Section: Discussionmentioning

confidence: 99%

Civil liability related to imaging exams in Brazil

Fontana¹,

Liedke²,

Fontoura³

et al. 2015

Braz. J. Oral Sci.

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“…Diagnosis seems to be the major pitfall for radiologists [ 14 ]. In daily practice, around 3–5 % of radiological analyses contain errors [ 56 – 60 ]; errors in interventional procedures and adverse events occurring during a radiological examination take second place in this negative ranking [ 61 ].…”

Section: Medical Liabilitymentioning

confidence: 99%

Use of contrast media in diagnostic imaging: medico-legal considerations

et al. 2015

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Contrast media (CM) are used in imaging techniques to enhance the differences between body tissues on images. The ideal contrast medium should achieve very high concentration in the tissues without producing any adverse effects. Unfortunately, this has not been possible so far and all CM have adverse effects. The increasing use of CM is likely to give rise to a wide range of pitfalls, including compliance with and appropriateness of indications for the use of CM themselves, the choice of the ‘best’ contrast agent, off-label use, evaluation of special populations of patients, and competence to tackle emergency scenarios following the administration of CM. Even more prominent, and potentially more important, is the issue of informed consent which brings with it a duty to inform patients awaiting the administration of CM with regard to the nature of the procedure, the existence of alternative procedures, the extent of the risks relating to the use of CM and, finally, the risks relating to refusal of the procedure. All these issues may give rise to concerns about liability for failure to offer adequate information to patients or to carefully evaluate and balance the potential risks and benefits of the procedure or, finally, for being unprepared in the event of adverse reactions to CM, especially when these are severe and life-threatening. Educational and training programmes for radiologists are likely to shape change in the medical liability environment in the coming years.

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“…In our digital era, however, the speed and ubiquity of transmission of radiological information to other departments such as operating rooms, has added a critical determinant when the information is affected by errors, incomplete, or unavailable [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Efficiency and Effectiveness of an Innovative RIS Function for Patient Information Reconciliation Directly Integrated with PACS

et al. 2012

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In RIS-PACS systems, potential errors occurring during the execution of a radiologic examination can amplify the clinical risks of the patient during subsequent treatments, e.g., of oncologic patients or of those who must do additional treatments based on the initial diagnosis. In Reggio Emilia Province Diagnostic Imaging Department (REDID) we experienced different strategies to reduce clinical risks due to patient reconciliation errors. In 2010, we developed a procedure directly integrated in our RIS-PACS that uses Health Level 7 (HL7) standard messaging, which generates an overlay with the text "under investigation" on the images of the study to be corrected. All the healthcare staff is informed of the meaning of that overlay, and only the radiologist and the emergency services staff can consult these images on PACS. The elimination of image overlay and of any access limitation to PACS was triggered to confirm of the right correction made by RIS-PACS system administrator (SA). The RIS-PACS integrated tool described in this paper allows technologists and radiologists to efficiently highlight patient exam errors and to inform all the users to minimize the overall clinical risks, with a significant savings in costs. Over the years, we have observed a steady decrease in the percentage of reconciled studies. Error reconciliation requires an effective and efficient mechanism. The RIS-PACS integrated tool described in this paper enables technologists and radiologists to quickly and efficiently highlight patient exam errors and inform all the users. Next generation of RIS-PACS could be equipped with similar reconciliation tools.

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Clinical Risk Management in radiology. Part I: general background and types of error and their prevention

Cited by 10 publications

References 36 publications

Civil liability related to imaging exams in Brazil

Civil liability related to imaging exams in Brazil

Use of contrast media in diagnostic imaging: medico-legal considerations

Efficiency and Effectiveness of an Innovative RIS Function for Patient Information Reconciliation Directly Integrated with PACS

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