A Focus On: Quality and Safety in Radiology

A Focus On: Quality and Safety in Radiology


Deming's Plan-Do-Check-Act Cycle. Reproduced from http://commons.wikimedia.org/wiki/File:Deming_PDCA_cycle.PNG



The ‘Quality and Safety Movement’ in medicine is said to have had its beginnings in the 1999 publication of To Err is Human by the United States’ Institute of Medicine. However, it probably dates back a bit farther to publication of the Harvard Medical Practice Study on the incidents of errors and adverse events occurring in hospitalized patients by Brennan, et al. in 1991, and a follow-up paper on medical errors by Dr. Lucien Leape in 1994. 


Physicians responded to this grave information energetically.  There was rapid widespread adoption of common safety procedures used in other industries, such as reliance on checklists, distinctive labeling for critical items such as medications, the use of formal ‘time outs’ for procedural verification, and even error-preventing ‘human factors engineering’ tools.  


In recent years, the radiology department has become a true ‘hub’ of hospital operations: the radiology department communicates daily with other departments and most patients will pass through radiology during their hospital stay. As clinical decision-making has increasingly come to depend on medical imaging, error prevention and process improvement within  radiology departments were soon viewed as being of paramount importance; it was not long before distinct and customized Quality and Safety programs for radiology were established.  In a relatively short time a substantial body of knowledge, experience, and perspective has accumulated in Radiology Quality and Safety.    


In a very real sense, the Quality and Safety movement in radiology is a direct consequence of   physician’s core agenda since the time of Hippocrates.  It is a direct extension of  what we commonly refer to as ‘professionalism,’ the essence of which is altruistically serving their patient’s needs in all situations, including advocating on behalf of individual patients when the healthcare delivery system is flawed in some way, or for whatever reason fails to put the patient’s needs first.  Whenever possible, mistakes must be avoided, but when not avoided, mistakes should become opportunities for continuous learning and improvement. This is the core essence of the Quality and Safety ‘movement.’ 

Michael A. Bruno, MD, FCAR, Associate Professor of Radiology and Medicine, and Director of Quality Services and Patient Safety, Department of Radiology, Penn State Hershey College of Medicine, Hershey, Pennsylvania, USA.

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