Examination

4.2.3.1. Patient confidentiality and physical privacy

The audit team should:

(a) Check the policies and procedures of the radiology facility regarding security and confidentiality of patient information;

(b) Check the policies and procedures of the radiology facility regarding care of the physical privacy of patients;

(c) Observe handling of patient request forms, file notes and records, to confirm compliance with policies;

(d) Inspect the physical environment of areas for waiting, changing clothes, examination, post-procedure observation and counselling;

(e) Discuss confidentiality and privacy protocols with staff;

(f) Observe patient care in the facility for compliance with personal privacy policies.

4.2.3.2. Imaging technique

The audit team should:

(a) Review the protocols for all imaging examinations, including those for special populations such as paediatric patients, and check for updating of documentation;

(b) Check protocols for optimization of image quality and dose;

(c) Determine the location and availability of documented examination protocols;

(d) Check for availability of printed and electronic copies of radiography technique information and parameters;

(e) Interview staff regarding awareness of, and adherence to, examination protocols;

(f) Ask radiological medical practitioners to provide examples of images of examinations that are tailored to address patient problems (routine and specific);

(g) Interview radiographers or radiological medical practitioners/physicians who are in-training, to discuss protocols for supervision and handling of unexpected imaging findings or for technical difficulties;

(h) Examine images for completeness of labelling and technique details;

(i) Check records for patient- and examination-specific documentation of, for example, contrast usage and scan parameters;

(j) Check records for notes regarding administration of medication for, for example, sedation and resuscitation;

(k) Review policies and procedures for infection control;

(l) Check room cleanliness and facilities for disposal of general and contaminated waste;

(m) Interview staff regarding their awareness of, and adherence to, policies and procedures related to infection control, including sterilization protocols;

(n) Check for provision of sharps protection;

(o) Observe the conduct of relevant examinations for compliance with operator technique, adherence to sterile techniques, patient safety, etc.

4.2.3.3. Clinical care, patient sedation/anaesthesia and contrast agents

The audit team should:

(a) Check that all elements of clinical care are provided for, with written records of monitoring of vital clinical signs, maintenance of IV equipment, drainage catheters, etc.;

(b) Check the physical environment for patient safety and privacy;

(c) Check the policy for use of sedatives and anaesthetics;

(d) Identify the designated staff members and discuss their role in the maintenance of drugs, gases and equipment for sedation and anaesthesia, and their inventories;

(e) Check policies and procedures for storage and administration of contrast agents, as well as staff authorization, dose protocols, etc.;

(f) Discuss contrast protocols with staff;

(g) Check for policies and procedures for the management of untoward events such as contrast medium reactions and cardiopulmonary collapse;

(h) Identify the designated staff members and discuss their role in the maintenance of resuscitation drugs, gases and equipment, and their inventories;

(i) Examine the availability, accessibility and contents of resuscitation resources;

(j) Discuss with staff and examine documentation regarding staff training and competencies for resuscitation;

(k) Check the availability of trained staff for resuscitation.

4.2.3.4. Image quality

The audit team should:

(a) Review a sample of images from different examination procedures and assess the image quality;

(b) Interview staff regarding their awareness of factors contributing to image quality;

(c) Identify the radiographer responsible for the radiographic QA programme, and discuss their roles and responsibilities;

(d) Interview staff regarding their awareness of image quality evaluation criteria for various examination procedures;

(e) Review records of image quality audits, and records of analyses of rejected and repeat images;

(f) Discuss with radiography staff the feedback given to them about their individual performance;

(g) Check for the process regarding provision of feedback by radiological medical practitioners regarding suboptimal images;

(h) Check for the process for discussing image quality difficulties with the reporting radiological medical practitioner.

4.2.4. The imaging report The audit team should:

(a) Observe the reporting environment to confirm the presence of prior studies and reports, and reviews of them;

(b) Analyse a random sample of examination reports to assess their contents, including clinical indications, a description of the technique used, imaging findings and their correlation, and guidance for further management;

(c) Review a random sample of reports to confirm the presence of final signatures;

(d) Request a sample of reports in which untoward effects have been documented.

4.2.5. Report communication The audit team should:

(a) Review departmental process documentation for ensuring that all completed examinations are reported and that reports are distributed effectively;

(b) Review a sample of reports to assess whether reports are thorough and timely;

(c) Discuss with staff the methods of report communication;

(d) Check medical records for documentation that urgent and emergency results are communicated appropriately;

(e) Interview referring medical practitioners for their satisfaction with the timeliness, appropriateness and completeness of reporting;

(f) Review audit records of report communication.

4.2.6. Continuity of clinical care The audit team should:

(a) Examine departmental rosters for multidisciplinary clinico-pathologic correlation meetings, tumour boards and morbidity/mortality conferences, and results recording;

(b) Assess documentary evidence of attendance of radiological medical practitioners and other radiology staff at multidisciplinary clinico-pathologic correlation meetings, tumour boards and morbidity/mortality conferences;

(c) Review examples of tracking of patient outcomes;

(d) Assess documentary evidence of internal and external audits of involvement of individual radiological medical practitioners in reviews of patient outcomes.

4.2.7. Accident and incident reporting The audit team should:

(a) Examine documented protocols for handling of patient safety incidents and sentinel events;

(b) Review the log book of critical incidents, for example, sentinel reports, their analysis and resulting actions;

(c) Review the log book of serious patient safety incidents for the manner in which the incidents are reported, analysed and responded to;

(d) Request evidence of quality improvement initiatives derived from accident and incident analysis.

4.2.8. Record and image retention