Australian sonographers' perceptions of patient safety in ultrasound imaging: Part two - translation into practice

Introduction

A lack of patient safety research hampers capacity to improve safety in healthcare.Ultrasound is often considered 'safe' as it does not use ionising radiation, a simplistic view of patient safety. Understanding sonographers' actions towards patient safety is crucial; however, self-reported measures cannot always predict behaviour. This study is part of a PhD exploring patient safety in medical diagnostic ultrasound. The aim of this paper is to explore sonographers' responses to the patient safety concerns identified in Part one of this study. The ultimate aim of the study is to inform the final phase of the doctoral study which will consider the next steps in improving the quality and safety of healthcare experienced by patients.

Methods

A qualitative study using semi-structured, one-on-one interviews. The Theory of Planned Behaviour (TPB) explained how sonographers respond to perceived patient safety risks in practice.

Results

Thirty-one sonographers were interviewed. Based on the seven themes identified in Part one of the study, results showed that incongruences exist between identifying patient safety risks and the actions taken in practice to manage these risks.

Conclusion

The TPB showed that behavioural, normative and control beliefs impact sonographers' responses to perceived patient safety risks in practice and can lead to risk avoidance. Lack of regulation in ultrasound creates a challenge in dealing with Fitness to Practice issues. Collective actions are required to support sonographers in taking appropriate actions to enhance patient safety from multiple stakeholders including accreditation bodies, regulatory authorities, educational institutions and employers.

Australian sonographers' perceptions of patient safety in ultrasound imaging: Part 1 - identifying the main safety concerns, a qualitative study

Introduction

Patient safety has been an undervalued component of quality healthcare but is a challenging area of research.Ultrasound is the most common imaging modality in the world. Research on patient safety in ultrasound is generally focused on bioeffects and safe operation of ultrasound equipment. However, other safety issues exist in practice that warrant consideration.This paper forms the first part of a PhD study exploring patient safety in medical diagnostic ultrasound, beyond the notion of bioeffects.The ultimate aim of the study is to inform the final phase of the research study which will consider the next steps in improving the quality and safety of healthcare experienced by patients.

Methods

A qualitative study using semi-structured, one-on-one interviews. A thematic analysis categorised data into codes and generated final themes.

Results

A heterogeneous mix of 31 sonographers, who reflected the profile of the profession in Australia, were interviewed between September 2019 and January 2020. Seven themes emerged from the analysis. These were bioeffects, physical safety, workload, reporting, professionalism, intimate examinations and infection control.

Conclusion

This study presents a comprehensive analysis of sonographers' perceptions of patient safety in ultrasound imaging, not previously available in the literature. Consistent with the literature, patient safety in ultrasound tends to be viewed in technical terms through the potential for bioeffects of tissue damage or physical harm to the patient. However, other patient safety issues have emerged, and while not as well recognised, have the potential to negatively impact on patient safety.

Regulation of healthcare and medical imaging in Australia: A narrative review of the evolution, function and impact on professional behaviours

OBJECTIVES

This review explores the literature about the status and influence of statutory regulation in healthcare with a focus on medical imaging. It summarises the status of regulation in Australia for radiographers and sonographers, with brief reference to the global situation. The role of regulation is explored in terms of its evolution, function and effect on professional behaviours.

KEY FINDINGS

Reports of medical errors, sentinel events and professional misconduct in healthcare have raised concern about how health care professionals are regulated. Patient-centric healthcare delivery has changed how people interact with healthcare, contributing to the development of statutory regulation for many healthcare professions. In Australia, the Health Practitioner Regulation National Law (The National Law) 2009, established the National Registration and Accreditation Scheme (NRAS) in order to practice. Not all health care professions are included in the scheme. In medical imaging, radiographers are included but sonographers are a notable exception. Regulation is designed to positively influence practitioners' professional behaviours. The available evidence however is limited, but suggests that under certain circumstances, it can negatively impact practitioners' professional behaviours.

CONCLUSION

Statutory regulation has been implemented to address serious issues highlighted in reports of medical errors and professional misconduct, but it may have unintended consequences on the professional behaviours of practitioners. Limited research means the relationship between statutory regulation of healthcare practitioners and its impact upon professional behaviours remains unclear.

IMPLICATIONS FOR PRACTICE

If statutory regulation of healthcare professionals is to achieve its aim of protecting the public, it is imperative that we understand the impact that it has on professional behaviours. This review highlights that it can negatively impact professional behaviours which may be detrimental to patient's safety.

Written Feedback on Thermal Index During the First-Trimester Nuchal Translucency Examination Does Not Improve Compliance With the “as Low as Reasonably Achievable” Principle

Objective: The null hypothesis was that there would be no change in as low as reasonably achievable (ALARA) behavior based on feedback from comments on the nuchal translucency quality review (NTQR) image submissions. Methods: A review of the Perinatal Quality Foundation Database found 206 practitioners who failed their first credential attempt and received ALARA comments as feedback. The second submissions of the same subjects were reviewed to determine if compliance with ALARA improved following written feedback. Results: Seventeen percent of all second submissions addressed ALARA. Sixty-one percent of second submissions passed, however only 18.4 % of those addressed ALARA. Among those who submitted thermal index at bone values on both first and second submissions, the mean values on the second submission were 0.20 lower compared to the first submission ( P = .0288). Second submission mean thermal index at bone values were 0.68 lower among those submissions with ALARA concerns addressed compared to those not addressing these concerns ( P < .001). Conclusions: Written feedback without consequences on the ALARA principle did not improve compliance.