Discussions of patient safety have begun to include the issue of health care staffing shortages. Some fear staff training and credentialing standards will be lowered as health care organizations struggle to provide patient care in the face of a shrinking labor pool. Recent studies such as the one by staff at the Houston Medical School documenting skin injuries to patients during fluoroscopy highlight the danger of allowing under-trained staff to perform potentially risky procedures.
Some professional organizations, including the ASRT, have been lobbying hard in support of adequate training and credentialing standards for radiologic technologists. When the American College of Cardiology (ACC) recently released its Clinical Expert Consensus Document on Cardiac Catheterization Laboratory Standards, the ASRT questioned its recommendations for non-nursing personnel. The consensus document stated that “at least one technologist, who may or may not be a certified radiological technologist, should be skilled in radiographic and angiographic imaging principles and techniques.”
The ASRT was quick to respond to the recommendation. In a May letter to the ACC as well as the Society for Cardiac Angiography and Interventions, ASRT President Michael DelVecchio asserted that “to minimize radiation exposure levels, the ASRT believes all technologists who operate medical imaging equipment should be certified by a nationally recognized credentialing body. Uncertified personnel should not be permitted to perform radiologic procedures in the catheterization lab or in any other medical setting.”
The letter goes on to suggest that the section on non-nursing personnel be revised the next time the document is updated to recommend that imaging procedures in the catheterization lab be performed only by certified technologists who have been educated in radiation protection.
ASRT’s stance is based on its support of the Consumer Assurance of Radiologic Excellence (CARE) bill, which if approved by Congress would establish educational and credentialing standards for personnel who perform all medical imaging examinations except ultrasound.
One study has offered evidence that, when properly trained, technologists can meet the challenges brought on by an expansion of duties. Researchers at the Cleveland Clinic found that R.T.s given additional training in technique, anatomy and basic pathology and initially given supervision ultimately can safely and successfully perform gastrointestinal fluoroscopy. The specially trained R.T.s ultimately learned to perform esophagography and double-contrast barium enema exams “without an unacceptably high radiation dose,” the study showed. The study was published in the November 2000 American Journal of Roentgenology.
Until adequate training and credentialing processes are firmly in place, however, the general conclusion is that we will have to wait patiently and guard vigilantly against complacence when it comes to radiation dosages.
In the meantime, Dr. Thomas B. Shope, Ph.D., of the FDA’s Center for Devices and Radiological Health suggests that hospital administrators and risk management personnel take charge by creating safety requirements for staff with fluoroscopy privileges and putting training programs in place in medical facilities. Some hospitals, such as those at the University of Virginia at Charlottesville and the University of Minnesota, have already done so, Dr. Shope said.
Louis Wagner, M.D., a co-author of the study on radiation burns during fluoroscopy, is among those applauding such efforts. As he noted in an interview with ABC News, “It has taken a long time, but more health professionals are beginning to wake up to this issue because it is getting harder to ignore the type of data that is becoming available. But there is still a lot of catching up to do.”