LSU Health Sciences Center Radiology Department Proc 10.

12

PACS/RIS Image Processing Errors Purpose: To establish guidelines for the communication of processing errors associated with the RIS tracking and image archiving. The policy will also provide the associated accountability for recognizing and correcting errors as well as the actions that will be taken for those errors that cannot be corrected or impact the patients medical records. These guidelines are intended to ensure that accurate information is available for the diagnosis and treatment of patients. Definitions: Tracking errors are a result of not following procedures or intentional misuse by a user. This problem has a number of facets but all can potentially jeopardize patient care by having the wrong images assigned to a patient, no images present, etc. In addition, tracking errors can also lead to incorrect billing. The most common tracking errors are listed below: 1. Failure to track or incomplete tracking The physicians interpretation can not be transcribed and placed in the patients medical record. 2. Track as complete but later finding and correcting an error Errors must be corrected but it is important to realize that the correction will not be made in the patients lifetime clinical record or the hospital information system. 3. Tracked as complete but not correct This error can result in several issues including billing a patient incorrectly, 0 images for the test and a flawed electronic medical record. 4. Incorrect tracking times Exams that are tracked at the same time will result in the 2nd exam not being recorded in the lifetime clinical record. 5. Entering incorrect information a - Entering incorrect patient information goes beyond a RIS tracking error. It does result in incorrect data in the RIS; however, this type of error is in violation of good clinical practice and hospital policy. As an example, entering a test as done on a day prior to that stipulated by the physicians order, is considered failure to follow a physicians order. b Placing one patients images in another patients file is considered patient misidentification. The seriousness of the error depends on the step at which it is caught. Before being sent to PACS If the error is caught and immediately corrected then there is no impact on the patients care or medical record. Before being read If the error is caught before the radiologist completes interpretation then the medical record is not affected but any physician who has already viewed the images has seen the incorrect images. 6. Canceling order with images present This error results in images being on PACS but no report or record of the exam will be available. This can only occur by canceling an order improperly and can create a situation in which the physician would not have the

appropriate information to diagnose or treat a patient. Exceptions: coroners radiographs, mag rings, etc. a. Exam must be reordered and images moved into new folder on PACS. New order must also be tracked on RMS. b. If exam must be cancelled all images must be deleted from the exam folder on PACS. Policy: All image processing errors must be documented for the purpose of quality assurance. This data will be trended to determine if steps of the process are causing a problem, equipment failure is a problem or additional staff education is needed. Since the image and associated data is a critical component of the patients care, all errors will be reviewed and staff will be held accountable for policies and procedures. Since these errors vary in the degree of consequence, there must be varying levels of corrective action. In order to initiate corrective action, errors will be divided into the following categories with the listed steps taken for corrective action. 1. Errors corrected by technologist with no impact on the patients medical record: No penalty is associated with this error; however, repetitive errors can increase the potential for a more serious error. An employee with a corrected error rate of greater than 2% of exams performed will undergo additional training and may be reviewed for disciplinary action if the problem continues. 2. Errors that cannot be corrected by technologist but are corrected by the supervisor with no impact on patients medical record: same as item 1 3. Errors that cannot be corrected or corrected errors that impact the patients medical record: Any error that impacts the medical record has the potential to lead to current or future problems with the patient medical care. a. Errors that are recorded and reported: First Occurrence verbal notification Second Occurrence the user will be counseled and required to provide a written response. Third Occurrence mandatory education and competency check Fourth Occurrence - review by the section manager and department director for possible disciplinary action. ***The employee may have two occurrences within 3months. An occurrence outside of this timeframe will start the process over. b. Errors that are not recorded or reported: First Occurrence the user will be counseled and required to provide a written response. If during this review it is determined that the user needs additional education, this will be provided and competency checks performed. Second Occurrence written warning Third Occurrence review by the section manager and department director. ***The employee may have one occurrence within 3months. An occurrence outside of this timeframe will start the process over.

4. Entering incorrect information Incorrect information will be treated the same as charting incorrect information in a patients chart. First occurrence written warning Second occurrence written reprimand with review for disciplinary action 5. Intentional misuse of the system by entering false data will result in a review by the section manager and department director for disciplinary action. Monitoring of Errors The shift supervisor will monitor the worklists to ensure all exams are tracked properly. This process should be ongoing during the duration of the shift, but double checked at the end of shift. The shift supervisor should also ensure there are no unspecified images on PACS, if there are unspecifieds they should be corrected IMMEDIATELY. In addition, all technologists must report any error they find immediately to their shift supervisor. All staff should understand that errors could lead to misdiagnosis and/or incorrect treatment of a patient. Written: December 2003 Revised: 12/18/06 Reviewed: 01/09 Revised: 03/10/11