Preventable Adverse Events More Common in Interventional Radiology

It is time to take a closer look at the error rate associated with interventional radiology procedures, according to researchers from Boston University School of Medicine. The success rate for these services is high, but more quality and safety education could lead to even better outcomes and fewer follow-up interventions.

Medical errors have been a concern long before the Institutes of Medicine issued its “To Err is Human” report in 2000. Even then, these mistakes led to 98,000 deaths that occurred in American hospitals. That threat is more serious now, said Mikhail C.S.S. Higgins, M.D., MPH, assistant professor of radiology at Boston. Today, it is estimated that medical errors are responsible for more than 250,000 deaths annually in the United States.

And, the medico-legal implications are significant. Every year, 7.4 percent of physicians find themselves embroiled in a lawsuit, he said. Nearly 20 percent of those providers come from procedure-oriented sub-specialties. With radiologists already facing a higher proportion of lawsuits, this puts interventional radiologists in a potentially precarious position even though the overwhelming majority of cases – 82 percent, according to one recent study – are found in favor of the defending interventional radiologist.

To date, there has been little research into how many of these adverse events occur in the sub-specialty. Existing data indicated that most of these errors are preventable, occurring mainly due to improper device positioning or device misuse or malfunction. In a new review article, published in Radiology, Higgins and his team assert that, even though most interventional radiology procedures succeed with few-to-minor complications, it is time to take a fresh look at these adverse events to better understand what is behind them and the complications within interventional radiology.

“When complications do occur, however, they can be associated with considerable morbidity, and treatment of these complications can lead to more invasive correctional procedures, thus exposing the patient to even greater cumulative risk of harm,” said Higgins, who is also associate director for the Early Specialization in Interventional Radiology program at Boston Medical Center and founding chair of the Radiology Interventions Safety Quality and Complications Symposium.

Consequently, he added, the industry should double-down on its efforts toward patient safety and quality assurance in clinical practice, continuing medical education, and graduate medical education.

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By paying attention to the characteristics of interventional radiology procedures that can open the door to a medical error – and increasing efforts to create new safety practices that focus on those areas of weakness, he said, it is possible for providers to reduce the likelihood that these mistakes will happen.

To reach this goal, he and his team recommended some changes in approaching medical errors:

• Changing the culture to encourage blame-free error reporting
• Educational initiatives for preventing and managing procedural complications
• Improved training for non-physician interventional radiology staff

They also suggested several steps for minimizing liability risk:

• Identify the person best suited to treat a complication
• Consult other specialties when needed
• Ensure all providers are aware of an agreed-upon proposed plan
• Talk to the patient or family about what happened
• Contact hospital risk management to correctly document complications and management, and have a timeline of events around the complication with supporting documentation
• Keep a record to every action taken, including pre-operative risk discussion and informed consent procedures
• If appropriate, report the event to departmental or national governing bodies
• Launch a root cause analysis and document the process to prevent future errors
• When appropriate, relay findings and any procedural changes to the patient and/or family

According to Higgins and his team, there are several things specific to interventional radiology that can make a difference. But, one strategy in particular – checklists – has been found to be helpful in improving patient safety. Based on existing reports, using this tool can decrease major complications and lower post-procedural mortality by 36 percent.

“The underlying goal of these safety aids is to reduce needless variance, thus proactively mitigating the risk of complications,” he said. “An added benefit of checklists is that they can strengthen the team dynamic by encouraging communication, and important aspect of an organization’s safety culture.”

Ultimately, if providers better understand what factors can lead to a medical error, they will be better prepared to take the necessary precautions to guard against them, Higgins said. In addition, implementing a reporting system that pivots away from being accusatory in nature can also help improve patient outcomes.

“By choosing to embrace a reinvigorated commitment to patient safety and quality assurance in interventional radiology practice and education,” he said, “the specialty can continue its steadfast evolution on a progressive trajectory that ensures a continued and more optimized quality of care for its patients.”