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Reviewing new ambulatory EC standards reveals MRI and diagnostic imaging best practices for hospitals


June 1, 2010

Future changes in acute care?

Reviewing new ambulatory EC standards reveals MRI and diagnostic imaging best practices for hospitals

Although new elements of performance (EP) for advanced diagnostic imaging only appear in the EC chapter for ambulatory providers, these requirements may still be worth hospitals’ attention.

For starters, the disparity now between the ambulatory and hospital EC chapters when it comes to MRI and radiology safety results in a more strenuous approach for ambulatory settings, says Tobias Gilk, M.Arch, president and MRI safety director at Mednovus SAFESCAN®, based in Leucadia, CA. SAFESCAN develops ferromagnetic detection products for MRI suites. 

“The Joint Commission hates disparities when they don’t need to be there between the hospital and ambulatory accreditation programs,” Gilk says.

The Joint Commission acted quickly to amend its ambulatory diagnostic imaging requirements after the Centers for Medicare & Medicaid Services (CMS) mandated that outpatient imaging providers become accredited by a federally designated organization by January 1, 2012.

“The Joint Commission has been going at a breakneck pace since December” to align with CMS’ rules, Gilk says.

CMS has designated the following organizations to provide advanced diagnostic imaging accreditation: The Joint Commission, American College of Radiology, and Intersocietal Accreditation Commission.

CMS’ 2012 deadline will affect more than 7,000 sites that utilize advanced diagnostic imaging, according to The Joint Commission. The rules apply to the technical component of MRI, PET, and CT services, but not to x-ray, ultrasound, mammography, or other imaging.


Passing over hospitals, for now

In some sense, The Joint Commission’s effort to revise its ambulatory accreditation standards has led to the organization bypassing similar hospital provisions. Yet inpatient facilities can take useful information from their outpatient brethren in terms of best practice and  also perhaps preparing for future changes in the hospital standards for advanced diagnostic imaging.

“[The Joint Commission is] going to be doing work on the hospital side,” Gilk says. “I’d bet my paycheck on it.”

The CMS ambulatory diagnostic imaging provisions don’t apply to hospitals that provide such services—at least not yet—because hospitals bill for this under different payment systems than ambulatory surgical centers. 


Changes within the EC standards

Let’s look at the specific imaging provisions that The Joint Commission added to the ambulatory standards.

Under EC.02.02.01 (managing safety and security risks, similar to the hospital version of the standard), new EP 14 requires ambulatory organizations that provide advanced diagnostic imaging services to manage MRI risks associated with the following situations:

  • Patients who experience claustrophobia, anxiety, or emotional distress in an MRI scanner
  • Patients who may require emergency care while in the scanner room
  • Metallic implants and devices entering the MRI suite
  • Ferromagnetic objects entering the MRI suite


Briefings on Hospital Safety has previously detailed the risk prevention steps surrounding the latter two bulleted items, but it may not be as clear how the first two items apply to the EC.

Regarding patients who need emergency care while in an MRI scanner room, Gilk believes this provision of EP 14 ensures that there is physical space to properly handle a patient who goes into a code blue (e.g., availability of a crash cart and medical gas hookups). You don’t want a code team running into an MRI room without properly screening them for metallic objects, a precaution that, on the flip side, might delay urgent care to the distressed patient, Gilk says. Therefore, ambulatory centers should keep a space outside of the immediate MRI scanner room equipped for resuscitation efforts.

As for the first bullet about claustrophobic patients, Gilk is surprised to see it on the list, because he can’t find a compelling connection in EC.02.01.01 between patient comfort and the physical environment.


Setting frequencies for image upkeep

Meanwhile, ambulatory standards EC.02.04.01 and EC.02.04.03 address medical equipment management and testing, again similar to the hospital EC chapter.

Under EC.02.04.01, new EP 7 mandates that the ambulatory organization identify activities and frequencies for maintaining the technical quality of diagnostic images. Also, EP 15 of EC.02.04.03 wants ambulatory sites to maintain the clarity and accuracy of images. Both EPs leave much in the hands of ambulatory centers to determine exactly how the provisions are carried out.

This approach differs from the stricter provisions of the American College of Radiology, which requires sites to use a “phantom”—an object filled with gel and a low-contrast test pattern—to test the parameters of an MRI scanner, Gilk says. He will be working with The Joint Commission to provide basic MRI education to its ambulatory surveyor roster.

The inequality of diagnostic image provisions between ambulatory and hospital settings may pressure The Joint Commission to introduce similar standards for acute care facilities. It’s not difficult to foresee affected ambulatory surgical centers decrying a double standard that hospitals need not meet, especially given that hospitals provide MRI services to patients who are more critically ill, Gilk says.

A good source of prevention steps for MRI accidents is the February 2008 Joint Commission Sentinel Event Alert (see the related story below).


Consider zoned approaches to keep people safe in MRI areas

In its Sentinel Event Alert about MRI safety, The Joint Commission quotes the American College of Radiology’s Guidance Document for Safe MR Practices.

A prominent piece of the guidelines discusses a zoned system of access restrictions into an MRI area:

  • Zone I: General public
  • Zone II: Unscreened MRI patients
  • Zone III: Screened MRI patients and personnel
  • Zone IV: Screened MRI patients under constant direct supervision of trained personnel


You can read the full guidelines at http://tinyurl.com/2m95qa.

You can also check out the Sentinel Event Alert at http://tinyurl.com/2htx47.

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