Interventional radiology and the WHO safety checklist

Created - 11.09.2010

Following the publication of the paper (N Engl J Med. 2009 Jan 29;360(5):491-9) in the New England Journal of Medicine in 2009, it became clear that significant reductions in surgical morbidity and mortality could be achieved with a simple checklist and said checklist was duly introduced and modified for different surgical specialties. 

Should this be introduced into interventional radiological practice?

One can see parallels in interventional radiology. We all know that that significant errors occur in all aspects of radiology despite current safeguards and those being reported officially are probably only the tip of an iceberg. There are many who feel that by carrying out image guided procedures we avoid many of the problems seen in the surgical specialties. But if we are honest, we know that this is simply not true.

We are all aware of cases during the course of our careers of incorrect site/procedures or the correct equipment not being available at critical moments leading to patient harm and the occasional needless death. The checklist concept is designed to prevent these rare but devastating mistakes. An otherwise brilliant career that spans 40 years can be defined by a single unnecessary death.

Any procedure that requires needle insertion into a patient has the potential for catastrophic consequences. No doctor wants to inadvertently harm patients during procedures, but errors will occur in every department and often for the daftest of reasons. The NPSA has clearly identified that the checklist should apply to all patients undergoing procedures under general or local anaesthesia. In collaboration with the RCR, a pilot was undertaken in nine hospitals to adapt the WHO checklist for use in Radiology. The WHO checklist is not intended to replace current good practice or protocols already in place, but are an additional safeguard. 

The checklist is designed to act as a ‘pause’ – to reflect before embarking on any procedure which requires the insertion of a needle into a patient for the purpose of biopsy or intervention. The pilot has demonstrated that the modified checklist can be easily applied to all departments regardless of their practice and takes no more than 2-3 minutes to perform. After consulting with those radiologists, radiographers and nurses who took part in the pilot, the checklist has now been further modified to make it even simpler, quicker and appropriate for the wide variety of procedures performed in most departments. There remains the potential to modify these locally to adapt to local needs and protocols but the basic checklist questions should not be altered.

The latest version of the checklist will be circulated to all departments shortly, with guidance notes on how they can be applied. An enlarged version of the form can potentially be put onto the wall in all procedural rooms. This can be read out by any member of staff before each case and documented in the notes and/or on RIS/PACS to reduce paperwork if so desired.

We have a duty of care to our patients to ‘do no harm’. We need to demonstrate that as interventional radiologists, seeking to be a professional subspecialty, that we take patient safety very seriously. The membership of the BSIR more than any other radiology group will hopefully welcome and embrace this addition to our practice. The modified WHO checklist is an extremely simple and useful tool in helping us to deliver a high quality service and improve patient safety.

Dr Raman Uberoi

Professor A Belli

Professor T Nichoslon