The Singapore General Hospital (SGH) Clinical Quality Conference (CQC) is a peer learning forum aimed at creating awareness of safety issues that need attention in clinical care. This year’s CQC focused on improving practices that will ensure and enhance patient safety in radiology departments.
Clinicians have to take heed of delivering quality care as patients entrust them with their health and safety. This is especially salient for the radiology departments, as unnecessary radiation exposure can potentially pose health risks to patients.

At this year’s Clinical Quality Conference (CQC) on 3 September, SGH’s Patient Safety Unit and Department of Diagnostic Radiology (DDR) shared case studies and practices with doctors, nurses and allied health professionals to improve safety for patients undergoing diagnostic radiological tests. 
The Conference focused on the importance of ascertaining the suitability of patients for Magnetic Resonance Imaging (MRI) and the guidelines for radiation exposure to women of child-bearing age.

The conference is targeted at creating awareness of safety issues that need special attention in clinical care. This year’s conference was chaired by Assoc Prof Agnes Tan, Chairman of SGH’s Division of Ambulatory and Clinical Support Services.

Safety procedures for Magnetic Resonance Imaging (MRI) 

According to Dr Matthew Ng, Head of the Department of Family Medicine & Continuing Care, ensuring patient safety for MRI scans involves ascertaining if the patient is suitable for MRI scans, as well as screening for metal objects such as implants, piercings and permanent pacemakers (PPMs – small devices placed in the chest to control abnormal heart rhythms).

These are important steps as MRI scans have often been ordered for patients with PPMs across various specialties.
Inadequate evaluation of these criteria can put patients at risk of harm.

The lack of due diligence can also adversely impact efficiency and resource allocation. When test slots are allocated to patients who are unsuitable for undergoing MRI scans, it deprives other patients who urgently require it.
It also consumes the radiographers’ and other healthcare providers’ time, thus delaying investigations and treatment plans.

Limiting pregnant patients’ exposure to radiation

There may be adverse consequences for the unborn child when the pregnancy status of female patients are not verified before diagnostic radiological tests. Exposure to radiation can increase risk of fetal malformation and childhood cancers such as leukemia.

Dr Chan Lai Peng, Senior Consultant in DDR, emphasised that radiological safety protocols must be enforced to limit unnecessary radiation exposure to pregnant patients. She stressed that Urine Pregnancy Test (UPT) should be performed on female patients of childbearing age to rule out possible pregnancies if they present more than 28 days after the start of their last menstrual period or they have missed their period.

This protocol is especially important as unmarried female patients may shy away from declaring possible pregnancy status due social stigmas.
To reduce potential risks, clinicians must take additional care to defer X-rays or scans on female patients with unknown pregnancy status to the ‘safe window’ unless there is strong clinical indications.

Best practices to improve patient safety

The speakers at the conference shared three effective ways to reduce cases of MRI contraindications:

Firstly, physicians should verify the presence of metal implants or PPMs with their patients before clicking the ‘Set all to NO’ checkbox. This selection auto-populates a ‘no’ response to all MRI-specific questions on the Computerised Physician Order Entry (CPOE) form.

Secondly, nurses should remind junior doctors to examine the chest and/or check the latest Chest X-ray to ascertain the presence of a PPM before ordering MRIs.

Lastly, doctors should contact the cardiologist regarding patients with PPMs should there be an urgent need for a MRI.
The organising committee from Singapore General Hospital’s Patient Safety Unit