Patient injury notices filed on fractures left unnoticed in the emergency room
A recent doctoral dissertation examined the background of imaging incidents that endangered patient safety. According to the dissertation, adverse events related to diagnosis could be prevented by means of, for example, more detailed follow-up examinations. Communication between the medical staff and the patient, on the other hand, ensures that the patient has a realistic understanding of their disease and the progress of the treatment.
The doctoral dissertation submitted by Master of Health Science Tarja Tarkiainen to the University of Oulu Graduate School, Faculty of Medicine, examined the adverse events, harmful incidents and near-misses that had occurred in medical imaging units and their underlying reasons. One set of data used in the study were the patient injury notices received by the Patient Insurance Centre. The study provided information on the frequency of adverse events related to imaging and the risks involved, as well as on the possibilities to prevent such events.
“The adverse events related to imaging could be prevented by requesting follow-up examinations in unclear cases. The radiologist can propose a computed tomography or magnetic resonance imaging examination to supplement an ultrasound examination finding that is difficult to interpret. Furthermore, the systematic review of radiological images together with different actors strengthens competence and reduces incorrect interpretations,” says Tarja Tarkiainen.
The largest number of imaging-related patient injury notices were filed on mammography, X-ray and MRI examinations. The majority of the notices were related to a delayed or incorrect diagnosis.
“The most common reason underlying the patient injury notices filed on basic X-ray examinations was a fracture that had remained unnoticed. This is something that should be paid attention to, especially during on-call hours when most of these examinations are carried out,” says Tarkiainen.
The equipment used in imaging can cause various kinds of adverse events for the patient. In addition to the radiation emitted by X-ray equipment and the attractive force of magnetic equipment, the potential causes underlying adverse events include complex equipment technology and limited competence related to the use of the equipment.
Not all diseases can always be cured, and there is no effective treatment available for all diseases. Healthcare and medical care involves risks that cannot always be avoided even if the medical staff acted in accordance with the best possible professional skill and knowledge. Such incidents are not cases of patient injury.
In the material related to the dissertation, approximately 30 percent of imaging-related notices of injury filed by patients resulted in compensation, and in most cases the reason was a delayed, incorrect or incomplete interpretation of the scan or negligence related to treatment. Compensable under the patient insurance are bodily injuries that occur in connection with healthcare and medical treatment that fulfil the criteria set out in the Patient Insurance Act. Compensation is paid, among other things, for situations where an experienced healthcare professional would have avoided the injury by acting differently in the situation concerned.
According to the dissertation, relatively fewer patient injury notices were filed on infrequently performed examinations such as blood vessel examinations or procedural radiology. According to Tarkiainen, this may be due to the fact that the risks associated with the examinations concerned are explained to the patients in more detail than the risks associated with more common imaging studies. Underlying many notices of patient injury is uncertainty concerning matters relating to the illness, injury or treatment, which are best resolved by discussing them with healthcare professionals.
“It could be concluded from the data that the diagnosis – in other words whether at issue is a malignant or a benign disease, and whether it is worth treating the disease or whether mere follow-up is sufficient – remained unclear to the patients. Both the diagnosis and the subsequent follow-up procedures should be better explained to patients,” Tarkiainen recommends.
Patients may file a patient injury notice with the Patient Insurance Centre that handles and resolves all the notices of patient injury concerning medical treatment and healthcare given in Finland. The processing free of charge, and it is carried out impartially and separate from the treatment process.
Additional information:
Tarja Tarkiainen, Master of Health Science, doctoral student, clinical expert, tel. +358 40 134 6864, tarja.tarkiainen@ppshp.fi
Patient Insurance Centre, Communications, tel. +358 40 450 4700
The Patient Insurance Centre handles all notices of patient injury concerning medical treatment and health care in Finland. The Patient Insurance Centre decides whether an injury is a compensable patient injury based on patient injury legislation. It also pays the compensation in accordance with legislation for those entitled to it. The Patient Insurance Centre safeguards patients and medical staff and produces information on patient injuries for the use of healthcare providers and insurance companies and in support of patient safety work and research. Its members include all insurance companies granting patient insurance policies in Finland.