TJC unveils revised standards for CT, PET, NM, and MRI services
First phase of imaging revisions goes into effect on July 1
The Joint Commission (TJC) is taking steps to beef up standards for diagnostic imaging services that are provided at hospitals as well as ambulatory care organizations. This follows a lengthy investigation and review period that was designed to consider improvements. "We convened an expert panel to bring people in who dealt with diagnostic imaging on a daily basis, and we also talked to our accredited customers as well," explains Joyce Webb, RN, BSN, MBA, CMPE, TJC’s project director in the Department of Standards and Survey Methods. "And the question we posed was, at a minimum, what should organizations be doing to insure that they are providing safe and effective imaging."
The comprehensive process followed requests from key TJC stakeholders to engage in discussions about radiation safety, adds Webb. "We became aware over the past year about several significant quality and safety issues that have been occurring around radiation safety," she says. "So we were looking for opportunities for our requirements to better capture and address risk as it relates to the provision of diagnostic imaging."
What TJC investigators gleaned from this process was that health care organizations need to make sure that they have competent personnel performing imaging tests, and they need to insure that their equipment is functioning properly, explains Webb. "They also need to be engaging in specific activities that relate to making sure that they are minimizing radiation exposure to patients and staff as well," she explains.
Once the information was collected and organized, the Oakbrook Terrace, IL-based accrediting agency reached out to stakeholders and providers for added input. "From these discussions, we drafted standards, posted them for public comment for six weeks, analyzed the feedback we got back from field reviews and public comments, and then finalized the standards."
Given the broad scope of the review, TJC plans to unveil changes to its imaging standards in phases, with the first group of changes set to go into effect on July 1, 2014. These changes focus on computed tomography (CT), nuclear medicine (NM), positron emission tomography (PET), and magnetic resonance imaging (MRI) services.
Phase one changes address safety, risks
The new standards establish a minimum competency level for radiology technologists, noting that they should register and become certified by July of 2015. The standards also call for annual performance evaluations by a medical physicist of equipment that is used to perform imaging studies.
In addition, the standards stipulate that the radiation dose used in a CT study should be noted on a patient’s clinic record, although TJC stopped short of prescribing who should make this notation. "We are developing a survey process around some of the specifics, but we try not to be so prescriptive in terms of how organizations do these things because they may be done by different people in different [work environments]," says Webb. "The aim [of this provision] is to increase awareness so that providers know what they have just exposed a patient to — what was the dose."
The revised standards also emphasize the importance of considering patient size or habitus when establishing imaging protocols, especially with regard to pediatric populations. Surveyors will be checking to insure that providers are aware of the principles and guidelines governing the safe imaging of children, and that health care organizations are providing adequate education in this area, explains Webb.
Regarding MRI, the new standards reflect concerns about safety risks associated with equipment that is brought into testing environment, and the proper evaluation and preparation of patients who will be undergoing this type of imaging test. "Typically, these tests produce a lot of noise, so some hearing protection [is important]," explains Webb. "It is also important to screen patients to make sure they don’t have any implants that would be problematic if they were introduced to the MRI environment."
Data collection is a key aspect of the new standards, particularly with respect to cases in which pre-identified radiation dose limits are exceeded. There can be medically appropriate reasons for utilizing a radiation dose that is outside of typical parameters, but these instances need to be documented and reviewed, stresses Webb.
Most health care organizations will find that they are already complying with most, if not all, of the new standards, observes Webb. "The first step is to look at what you are already doing, and then look at the standards and see where there are opportunities to make improvements," she says.
More imaging standards revisions are on the way. Phase two of TJC’s effort will focus on fluoroscopy, minimum qualifications for clinicians who perform imaging exams, and cone beam CT that is used in dental offices and oral-maxillary surgery practices. These changes will be unveiled in 2015. n
- Joyce Webb, RN, BSN, MBA, CMPE, Project Director, Department of Standards and Survey Methods, The Joint Commission, Oakbrook Terrace, IL. E-mail: email@example.com.