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Radiation safety training as risk management

October 06, 2020
Rad Oncology Risk Management
Thomas J. Petrone
From the October 2020 issue of HealthCare Business News magazine

By Thomas J. Petrone

Safety has to be a top priority for hospitals and health systems if they want to protect their employees and patients.
Failing to comply with safety training regulations opens them up to citations, penalties, litigation, and reputational damage as well. Yet safety training is not one-size-fits-all. The types of risks faced by employees in different positions, from custodial staff to cardiologists, vary widely. Both to minimize risks and to reduce liability, hospitals must provide tailored, diversified safety training to their various employees.

This is easier said than done.

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In safety training in general and in radiation safety in particular, the knowledge is there — many experts understand in fine detail the medical physics and engineering aspects of the equipment and its optimal calibration and operation. But effective safety training requires not only mastery of the content but mastery of instruction. Fewer experts are able to convey their knowledge in a way that appeals to the entire required audience. (Standing up and reading through a PowerPoint to a sprawling lecture hall may indeed allow a hospital to check the “compliance” box, but it is not how physicians, technologists, nurses, and other staff learn best.)

Instead of one massive radiation safety lecture delivered to whichever hospital employees can attend that year, safety lectures and training should take advantage of educational technologies and existing pedagogical insights. The information should be: 1) conveyed in an engaging and succinct manner, 2) pitched to the specific audience, 3) made available via different formats (think Cheryl Turner’s excellent “RadCast” continuing education podcasts), and 4) offered asynchronously to increase access. To achieve this balance and manage their risks, hospitals have started outsourcing certain aspects of their safety training.

New regulatory pressures
Starting in 2015, the Joint Commission issued increased regulatory requirements around safety in computed tomography (CT) dose optimization. Shortly after, strong requirements were introduced for fluoroscopy. Disturbing exposés about injuries from excess doses partly explain the increased regulation around CT. With fluoroscopy, over the past 10 to 15 years there’s been a non-negligible number of reports of skin burns from sophisticated fluoroscopic procedures — some of them serious enough to require skin grafts or other additional surgeries. Those reports are being acted on now, with more stringent fluoroscopy training being required in local jurisdictions in states including Texas, Massachusetts, and New York as well as the Joint Commission. For example, New York City now demands an 8-hour training for anyone who is going to do fluoroscopically guided interventional procedures. The training is fairly technical and is meant for physicians and assisting technologists who perform cardiac catheterization, cardiac ablations, and other types of therapeutic procedures that need long fluoroscopy times from machines with high output. Finding those hours is not easy.

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