Sentinel alert could presage accreditation changes
The Joint Commission returned the spotlight to patient radiation risks with a Sentinel Event Alert on the subject that invites the question of whether revised hospital accreditation standards may be coming down the line.
The alert issued Aug. 24 concerns the risks of most types of diagnostic radiation imaging, but the accreditation and quality group also is taking a look at the risks of therapeutic radiation and of the diagnostic treatment known as fluoroscopy, said Paul Schyve, senior adviser in healthcare improvement for the Oakbrook Terrace, Ill.-based Joint Commission.
The Joint Commission decided to issue the alert based on reports it received from hospitals, as well as because of media reports highlighting patients harmed by devices used for radiation treatment and diagnosis, Schyve said.
Given the risks and the growing popularity of CT scans and their ilk, the stakes are great. The alert notes that one study estimated that 29,000 future cancers and 14,500 future deaths could develop because of radiation from the 72 million CT scans performed in the U.S. in 2007. A separate study in the Nov. 29 issue of the journal Radiology found the number of annual emergency room visits that included CT scans increased by 500%—from 2.7 million to 16.2 million—between 1995 and 2007.
The alert suggests organizations do such things as ensure there is a culture of safety surrounding the use of radiation diagnosis devices, that providers ensure the right test is being conducted given the circumstance and that providers take steps to ensure the right dose is being given. Providers of diagnostic radiation should consider alternatives to radiation, such as MRIs; try to use the least radiation possible to accurately make a diagnosis; and rely on recommendations from expert organizations on using radiation devices, Schyve said.
Joint Commission officials continue to study other forms of medical radiation and haven’t decided whether to issue a Sentinel Event Alert on therapeutic radiation or whether to beef up its accreditation standards on the subject of radiation, but both are possible, Schyve said.
The American College of Radiology, which accredits imaging facilities, supports the idea of hospitals requiring accreditation for imaging, as are nonhospital providers, said American College of Radiology spokesman Shawn Farley. The college also endorsed the Sentinel Event Alert’s support for the creation of a national registry to track radiation doses to help create reference and optimal doses; the college offers such a registry currently for a fee, Farley said.
Nancy Foster, vice president of quality and patient safety with the American Hospital Association, was less enthusiastic about adding another reporting requirement and said patient-safety organizations are better suited to track such things. “We can’t have a registry for every single thing that goes on,” she said.