Systemic patterns of patient safety events in radiology: When, where, and why things go wrong

Patient Safety Events (PSE) in radiology are often addressed as isolated incidents and then archived, with limited system-level review. As a result, patterns and vulnerabilities remain hidden, limiting the potential for meaningful quality improvement.

To assess the value of a system-based approach for identifying patterns of harm, vulnerable populations, and key areas for improvement in radiology.

We retrospectively analyzed 25 months of safety event reports from a large academic medical center and affiliated facilities. PSEs were defined according to guidelines from the Agency for Healthcare Research and Quality (AHRQ) and categorized based on narrative descriptions. PSEs attributed to radiology were evaluated by type, patient demographics, radiologist involvement, and harm severity.

Of 22,285 total safety events, 719 (3.2%) were radiology-related; 591 (2.7%) involved patients. The most common categories were medication and contrast administration (23.0%), communication and coordination failures (21.5%), and patient handling and physical safety (19.3%). The mean age of patients with PSEs was 55 ± 23 years. Children (7.1% vs. 3.9%) and older adults (42.3% vs. 33.5%) were overrepresented. Radiologists were involved in 9.3% of events, primarily in diagnostic and procedural categories. Most PSEs (71.6%) resulted in emotional distress or no harm, with medication and contrast administration carrying the highest relative risk of patient harm.

A system-based analysis of radiology PSEs revealed recurring harm patterns and vulnerable populations. The findings highlight opportunities for improvement and emphasize the need for standardized classification and harm scales to support broader system-level quality efforts across institutions.