Checklist limits adverse events in interventional radiology

2020 03 03 00 55 4708 Interventional Radiology Fluoroscopy 400

Using a safety checklist to wrap up an image-guided procedure can significantly reduce the number of adverse events and the need for repeat procedures, according to a study published July 5 in the Journal of Vascular and Interventional Radiology.

In an effort to improve patient outcomes from interventional radiology procedures, researchers from Beth Israel Deaconess Medical Center in Boston led by Dr. Bettina Siewert adopted a postprocedure closeout checklist for image-guided procedures. They found that the initiative yielded a 43% reduction in the number of adverse events and an 80% lower need for repeat exams.

What's more, the researchers saw a decline in the severity of adverse events that did occur.

The research sprang from an effort to reduce adverse events that occurred during interventional procedures. After analyzing prior adverse events, the institution's radiology quality committee created a postprocedure closeout checklist, which was implemented on November 1, 2016, across all procedural service lines (vascular and cross-sectional interventional radiology, musculoskeletal, breast imaging, and neuroradiology).

The researchers then compared the annual number of radiology adverse events before (2015-2016) and after (2017-2021) the checklist was implemented.

Change in patient outcomes after implementation of postprocedure closeout checklist
  Percent of adverse events before adoption of postprocedure closeout checklist Percent of adverse events after adoption of postprocedure closeout checklist Improvement
Radiology adverse events 0.069% 0.034% 43%
Radiology repeat procedures 0.04% 0.007% 80%
Number of incident reports 18.5 per year 8 per year 58%

The difference in radiology adverse events and the number of radiology repeat procedures were statistically significant (p = 0.05 and 0.0033, respectively).

"While audits for the performance of the [postprocedure closeout checklist] have shown excellent compliance (94.2%-99.6%), not surprisingly, compliance was lower in the group of patients with procedural errors reported here (60%)," they wrote.

Adverse events categorized as class C based on Society of Interventional Radiology guidelines were due to repeat procedures: repeat biopsies and three guidewire removals, two of which were in the group of patients prior to the adoption of the checklist. The one SIR class D adverse event was due to a repeat lung biopsy that was necessary due to a specimen error with development of pneumothorax, chest tube placement, and increased length of stay due to the repeat procedure. That event occurred prior to the implementation of the checklist.

Overall, the study authors found a statistically significant difference in adverse event severity before and after the checklist was adopted (p = 0.009).

The researchers noted that procedural incidents still occurred after the checklist was implemented. A postprocedure checklist was not performed in 30% of incidents, but it would have caught the errors if it had been used.

And 70% of the incidents involved new error types that were not preventable with the current checklist, according to the authors. These errors included specimen and order mismatch when multiple specimens were obtained during the same procedure, incomplete order forms, and the wrong patient label on the order form.

"Thus, there is a role for review of any ongoing errors, and appropriate revision of the checklist to incorporate additional potential sources of error," Siewert and colleagues wrote. "With further modification of the [postprocedure closeout] checklist, 70% of incidents would have been preventable."

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