Identification of quality improvement areas in pediatric MRI from analysis of patient safety reports

Camilo Jaimes; Diana J Murcia; Karen Miguel; Cathryn DeFuria; Pallavi Sagar; Michael S Gee

doi:10.1007/s00247-017-3989-4

Identification of quality improvement areas in pediatric MRI from analysis of patient safety reports

Pediatr Radiol. 2018 Jan;48(1):66-73. doi: 10.1007/s00247-017-3989-4. Epub 2017 Oct 19.

Authors

Camilo Jaimes¹, Diana J Murcia², Karen Miguel³, Cathryn DeFuria³, Pallavi Sagar⁴, Michael S Gee⁵

Affiliations

¹ Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
² Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Quality and Safety Office, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.
⁵ Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA. msgee@mgh.harvard.edu.

PMID: 29051964
DOI: 10.1007/s00247-017-3989-4

Abstract

Background: Analysis of safety reports has been utilized to guide practice improvement efforts in adult magnetic resonance imaging (MRI). Data specific to pediatric MRI could help target areas of improvement in this population.

Objective: To estimate the incidence of safety reports in pediatric MRI and to determine associated risk factors.

Materials and methods: In a retrospective HIPAA-compliant, institutional review board-approved study, a single-institution Radiology Information System was queried to identify MRI studies performed in pediatric patients (0-18 years old) from 1/1/2010 to 12/31/2015. The safety report database was queried for events matching the same demographic and dates. Data on patient age, gender, location (inpatient, outpatient, emergency room [ER]), and the use of sedation/general anesthesia were recorded. Safety reports were grouped into categories based on the cause and their severity. Descriptive statistics were used to summarize continuous variables. Chi-square analyses were performed for univariate determination of statistical significance of variables associated with safety report rates. A multivariate logistic regression was used to control for possible confounding effects.

Results: A total of 16,749 pediatric MRI studies and 88 safety reports were analyzed, yielding a rate of 0.52%. There were significant differences in the rate of safety reports between patients younger than 6 years (0.89%) and those older (0.41%) (P<0.01), sedated (0.8%) and awake children (0.45%) (P<0.01), and inpatients (1.1%) and outpatients (0.4%) (P<0.01). The use of sedation/general anesthesia is an independent risk factor for a safety report (P=0.02). The most common causes for safety reports were service coordination (34%), drug reactions (19%), and diagnostic test and ordering errors (11%).

Conclusion: The overall rate of safety reports in pediatric MRI is 0.52%. Interventions should focus on vulnerable populations, such as younger patients, those requiring sedation, and those in need of acute medical attention.

Keywords: Children; Magnetic resonance imaging; Quality improvement; Safety; Safety report.

MeSH terms

Adolescent
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging / standards*
Male
Patient Safety*
Quality Improvement*
Retrospective Studies
Risk Factors