Patient Safety Issues in Radiology – Part One

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A Two-Part Series on Workplace Stress, Burnout, and the Risks to Patient Safety.

By: Dr. Cheryl Turner, Director of Global Education and Training at Legion Healthcare Partners; and founder of Rad-Cast, the CE Podcast for Rad Professionals.

Editor’s Note: Today’s blog is one of a series about the patient experience in radiology. In Part Two, the author shares real-life examples of adverse patient experiences in radiology. Be sure to check back on June 16 when we publish a new blog on Radiology’s Role in the Patient Experience written by Brigham and Women’s Hospital.

Medical imaging professionals work with very sophisticated technologies and potentially life-saving – or life-threatening – doses of radiation. We have our own particular set of stressors that can potentially cause patient safety issues in radiology. Soon, as COVID-19 restrictions lift, the demand for radiologic exams will increase heavily as we deal with the backlog of imaging exams that were put off during the height of the pandemic. (1) How will we cope with this added stress?

When I first began my own research into stress, coping, and burnout amongst radiology professionals, I naively entered with a superficial understanding of the situation. Very quickly, I learned that workplace stress runs deep and has a profound effect on the safety of patients and the well-being of all radiological science providers. The issue quickly became less about how we as professionals press on despite the challenges (we just do; that’s who we are) and much more about the far-reaching consequences of these disruptive and potentially dangerous experiences on patient safety.

Given that this will be a two-part series, let’s start from the beginning. What is workplace stress in radiology, what does it look like in practice, and how do we, as professionals, cope with all that is going on around us as we continue to provide patient care? Stress, by definition from the Oxford dictionary, is “a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances.” Our imaging and therapeutic work environments are definitely demanding and oftentimes adverse (see also harmful, unpleasant, or bad).

Root causes of potential patient safety issues

Now more than ever, radiologic technologists across modalities and therapists in cancer centers are being asked to do more with less. Stakes are high for increased productivity while also aiming to provide high-quality, high-technology, and high-accuracy levels of patient care.

What constitutes these levels of demand and adversity? To name a few: overwork, understaffing, increased technology, equipment upgrades, bullying, ineffective leadership, and decreased opportunities for training. Front line staffs are forced into situations in which they must make decisions without having real choices or full understanding of the processes in place.

For example, the American Society for Radiation Oncology [ASTRO], in their publication Safety is No Accident (2019), recommended that, “a minimum of at least two qualified individuals be present for any external beam treatment.” (2) This allows for technological support and a second set of eyes when delivering high dose radiation in the treatment of cancer. Due to staffing discrepancies and, sometimes, unrealistic patient volumes or schedules, radiation therapists find themselves alone while treating patients. While this experience is not widespread, those therapists working in centers that have not chosen to follow the suggestions of governing bodies are forced to perform solo. Clearly this is not a best practice, but it evidently meets the objectives for tighter personnel budgets, increased patient throughput, and greater overall departmental productivity. This experience does not fall on radiation therapists only. This quantity-driven approach is relevant to all imaging modalities.

Through discussions and interviews, it was revealed to me that front line staff feel they or their co-workers are woefully undertrained and underprepared to meet these fast-paced demands. I’m not saying that radiologic technologists and radiation therapists are under-educated; this is not the case at all. The difference lies in the commonsense approach to new equipment and/or new protocol training.

Many professionals believe that they and their teams are obligated to work in environments in which they are not fully proficient. In further attempts to save time, funds, and staffing, imaging sciences professionals are not provided with adequate, full-scope training on new equipment, new processes, or new patient care initiatives. Sometimes, vendor training is limited and ineffective. In many cases, a ‘super-user’ is trained and expected to pass that knowledge on to the rest of the team or. Department managers cannot afford to dedicate time and resources to extended training periods; there are too few staff members to allow for comprehensive education. Training becomes a box to be checked so that productivity may resume.

Leadership’s role in minimizing patient safety issues in radiology

All leaders have their own leaders. This means that every department manager answers to someone who is professionally superior. Leadership receives a lot of blame for negative workplace conditions. Though not always warranted, managers and directors must assume responsibility for the circumstances which affect their staff and their patients. Initiatives, coming down from executive leadership, must be scrutinized for relevant feasibility. Does this work? Does this affect quality of care? Does this instill best professional practice?

Leaders must also ensure that their employees are given the tools and the space needed to effectively provide patient care. Are staffing levels adequately met and are actual processes in place to promote composed and mindful attention? To protect staff and patients, chaos should be minimal. However, more often than not, radiation sciences workplaces are frenzied or disorganized. Leaders have a responsibility to ensure that efforts which truly support professionals are in place, allowing for a healthier overall dynamic of patient care.

Spoiler alert … how do we cope with all of this? According to my own research and that of others, we don’t really practice universal coping mechanisms (French, 2004; Poulsen, et al., 2014) (3). Instead, we attempt to overcome our workplace stressors through distancing and avoidance; we simply adapt to the situations in which we find ourselves. In the heat of our professional moments, we tend to just push onward so that we can achieve the goal of providing top-notch patient care.

In the second part of this series on workplace stress and patient safety issues in radiology, we will look into real-life examples of adverse patient experiences, including misadministration of radiation and more serious sentinel events. We will see, upon looking at root causes of these incidents, that oftentimes human error, miscommunication, and inadequate training and policies are to blame.

Read Part Two of Patient Safety Issues in Radiology.

Dr. Cheryl Turner has been a radiation therapist for over 30 years and an educator for 15 of those years. Cheryl currently serves as the Director of Global Education and Training at Legion Healthcare Partners and is the founder of Rad-Cast, the CE Podcast for Rad Professionals. She has extensive involvement in professional societies including the American Registry of Radiologic Technologists, American Society of Radiologic Technologists, the Joint Review Committee on Education in Radiologic Technology, Association of Educators in Imaging and Radiologic Sciences, and the Latin American Radiology Outreach organization. Cheryl was awarded the 2018 Harold Silverman Distinguished Author award, a 2015 ASRT Foundation Scholarship for continued education in pursuit of her doctorate degree, and the 2012 Chattanooga State Community College “Eye of the Tiger” Outstanding Educator accolade.

Learn More:

• Patient Safety Issues in Radiology – Part Two
• Measuring the Patient Experience in Radiology
• Radiologist Burnout Can Impact Patient Care and Personal Well-Being
• Increasing Adoption of Technology in Radiology
• Silencing Distractions in Radiology through Mindfulness Meditation
• Strategies to Increase Patient Satisfaction Scores

References:

1. Aunt Minnie. Is radiology prepared for a post-COVID-19 imaging surge?
2. American Society for Radiation Oncology (2019). Safety is No Accident. Retrieved from: https://www.astro.org/ASTRO/media/ASTRO/Patient%20Care%20and%20Research/PDFs/Safety_is_No_Accident.pdf
3. French, H. C. (2004). Occupational stresses and coping mechanisms of therapy radiographers – a qualitative approach. Journal of Radiotherapy in Practice, 4(1), 13-24.
4. Poulsen, M. G., Poulsen, A. A., Baumann, D. C., McQuitty, S., & Sharpley, C. F. (2014). A cross-sectional study of stressors and coping mechanisms used by radiation therapists and oncology nurses: Resilience in cancer care study. Journal of Medical Radiation Sciences 61, 225-232. doi: 10.1002/jmrs.87