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. 2022 Mar 18:10:846604.
doi: 10.3389/fpubh.2022.846604. eCollection 2022.

Detecting Patient Safety Errors by Characterizing Incidents Reported by Medical Imaging Staff

Tarja Tarkiainen  1 , Sami Sneck  2 , Marianne Haapea  3 , Miia Turpeinen  4 , Jaakko Niinimäki  1
Affiliations

Detecting Patient Safety Errors by Characterizing Incidents Reported by Medical Imaging Staff

Tarja Tarkiainen et al. Front Public Health. .

Abstract

The objectives of the study were to characterize events related to patient safety reported by medical imaging personnel in Finland in 2007-2017, the number and quality of reported injuries, the risk assessment, and the planned improvement of operations. The information was collected from a healthcare patient safety incident register system. The data contained information on the nature of the patient safety errors, harms and near-misses in medical imaging, the factors that lead to the events, the consequences for the patient, the level of risks, and future measures. The number of patient safety incident reports included in the study was 7,287. Of the incident reports, 75% concerned injuries to patients and 25% were near-misses. The most common consequence of adverse events and near-misses were minor harm (37.2%) related to contrast agent, or no harm (27.9%) related to equipment malfunction. Supervisors estimated the risks as low (47.7%) e.g., data management, insignificant (35%) e.g., verbal communication or moderate (15.7%) e.g., the use of contrast agent. The most common suggestion for learning from the incident was discussing it with the staff (58.1%), improving operations (5.7%) and submitting it to a higher authority (5.4%). Improving patient safety requires timely, accurate and clear reporting of various patient safety incidents. Based on incident reports, supervisors can provide feedback to staff, develop plans to prevent accidents, and monitor the impact of measures taken. Information on the development of occupational safety should be disseminated to all healthcare professionals so that the same mistakes are not repeated.

Keywords: errors; incident reporting; medical imaging; patient safety; risks.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The sequence of the patient incident reporting process.
Figure 2
Figure 2
Annual reports and risk assessments in medical imaging in Finland 2010–2017. *In 2007–2008, the risks were not assessed, and in 2009 only 14 were assessed, so these years are not included in the figure. **High and extreme risks are combined (n = 17).
Figure 3
Figure 3
Patient injuries assessed by supervisors in different modalities and other contexts in Finland 2010–2017. *Missing or unknown 26.3% (n = 1,916).
Figure 4
Figure 4
Reported patient harms with proposed measures in 2007–2017 in Finland.
See this image and copyright information in PMC

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