Vision-zero: a roadmap for implementing metal screening devices to reduce preventable harm during MRI

PURPOSE: This paper is a practical guide for implementing metal screening devices (MSDs) as part of an enhanced patient safety protocol prior to magnetic resonance imaging (MRI) procedures. DESIGN/METHODOLOGY/APPROACH: Six domains of quality are included: effectiveness, efficiency, appropriateness, acceptability, safety and sustainability. Improvement teams can use this guide, in whole or in part, to develop an implementation plan to meet their own clinical needs and operational requirements. The framework has three phases: pre-implementation, implementation and post-implementation, which can be conducted within 12 to 24 months. To determine if advanced screening reduces MRI-related preventable harm, regression analysis using Interrupted Time Series is described. Data on patient-reported harm is collected by a post-MRI survey delivered by telephone interview. Cost avoidance is estimated using burn injuries prevented, since burns are among the most common MRI-related injuries reported. FINDINGS: This framework was informed by a comprehensive literature review focused on identifying harm events related to MRI, root causes and innovations in safety for patients receiving MRI. A quality improvement approach is proposed because treatment and control experiments would not be recommended due to ethical considerations and feasibility/practicality for MRI departments. A comparison of pre- and post-implementation is an appropriate method for this purpose because it is applicable to small departments (i.e. single MRI units) and/or sites with low patient volumes. PRACTICAL IMPLICATIONS: Many MRI-related burns and other adverse events are preventable, yet these incidents continue to occur. Reducing or eliminating preventable harm improves patient experience, while providing assurance to health care providers that the diagnostic procedures do not result in preventable injuries or imaging failure, causing delays in diagnosis and treatment. The estimated value proposition suggests a typical investment would be cost neutral if only a single moderate harm event were prevented in one year of deploying MSD as part of an enhanced screening protocol. SOCIAL IMPLICATIONS: Technologies now exist to detect magnetic metal masses only or magnetic and non-magnetic metals at the same time. When accompanied by conventional screening procedures (patient-reported medical history, questioning and visual inspection), these devices show promise in reducing harm that might otherwise be considered unavoidable. ORIGINALITY/VALUE: The inspiration for this project came about through front-line clinicians unsatisfied with the status quo. While necessary, checklists and visual inspection alone inadequately protect patients from risk of injury. While solutions exist, widespread adoption of new technology and practices has not occurred in the clinical setting. This framework can be adapted or adopted, allowing improvement teams to evaluate cost, efficiency and effectiveness with the goal of eliminating preventable harm during MRI.