Is the image diagnostic? (10 point plan)
1. Patient Identification
Before checking the technical quality of the chest X-ray image the patient’s identity must be confirmed and the images assigned to the correct patient folder on PACS.
This would also be an appropriate time to check point 3 and ensure there is the correct annotation indication the technique used and the left/right side anatomical marker.
World Health Organization (WHO) stated in 2007 that throughout the health-care industry, the failure to correctly identify patients continues to result in wrong person procedures on patients and identity errors. These are still ongoing problems in diagnostic imaging
The English Care Quality Commission latest report for 2018/19 identifies 796 notifications of errors from ‘Significant Accidental or Unintended Exposure’ (SAUE). The most common type of error is still when the wrong patient receives an exposure, with 50% of all diagnostic imaging errors resulting from referrers failing to refer the right patient or operators failing to actively identify their patients. (Full report at: https://www.cqc.org.uk/sites/default/files/IRMER_annual_report_2018_2019_final.pdf )
Appendix 1 has some lessons learnt from the report
Initiatives developed like a ‘quality before speed’ mission statement to support the established ‘pause and check’ (Appendix 2) recommended by the UK Society and College of Radiographers were recommended in the report.
Professional bodies have produced guidance in the UK (Society and College of Radiographers (SCoR), Royal College of Radiologists (RCR) and Institute of Physics and Engineering in Medicine (IPEM)) in an attempt to reduce errors
The National Patient Safety Agency(UK) have also issued guidance (Appendix 3)