New data highlight 'systemic inconsistencies' in documentation of contrast reactions
New data are sounding the alarm on rampant inconsistencies in the documentation of hypersensitivity reactions to iodinated contrast used for CT scans.
Although uncommon and typically not life-threatening, hypersensitivity reactions have increased in recent decades alongside the significant rise in CT use. In most cases, repeat reactions can be avoided if they are noted appropriately during the first occurrence. However, a new study in European Radiology suggests that documentation of such instances varies widely, which could put patients at risk.
The team highlighted multiple factors at play that could inhibit the appropriate documentation of patients’ history.
“A radiology healthcare practitioner (radiographer, radiologist or radiology nurse) may access previous imaging history via a RIS, but only within the radiology department. In the absence of any being available, radiology healthcare practitioners may need to rely on the patient to provide information regarding their previous contrast experience, which is not always accurate,” C.L. Singh, with Charles Sturt University in New South Wales, Australia, and colleagues noted. “This is compounded by the current inconsistent implementation of interoperability between informatics platforms (RIS/PACS and EHR) leading to the compromise of safe and effective imaging decisions.”
The group conducted a scoping review of prior assessments of clinical documentation pertaining to patients’ histories of contrast administration. Using Bronfenbrenner’s adapted socio-ecological model, they sought to highlight how wide-ranging policies and interactions—departmental, hospital, government—affect inappropriate notations or omissions of clinical history.
The evaluation revealed widespread documentation inconsistencies across all levels of healthcare. At the micro level (between patients and practitioners) patients’ inability to provide accurate medical histories was often the culprit of omitted information on contrast hypersensitivities; at the meso and macro levels, which entail departmental and organizational policies, “fragmented systems, lack of interoperability and inconsistent terminology” were to blame for the observed inconsistencies. At the chrono level, which considers the effect of time and evolution, the group determined that the use of inefficient practices many years ago likely carried over without being adjusted, resulting in the continued perpetuation of inconsistent documentation habits for years.
Though they acknowledge that “there is no simple solution,” the authors suggested that a lack of standardized documentation protocols and training specific to hypersensitivity reactions both likely play a role in ongoing suboptimal practices.
“It would be naïve to propose a single format of reporting due to the complexities and variations in healthcare provision in addition to the multifactorial issues identified,” they noted. “However, immediately implementable contributions to ‘breaking the cycle’ by ensuring that any documentation by any practitioners (within radiology and beyond) includes the full name of the contrast, the date and time of reaction, clinical symptoms (severity and duration), treatment provided and response.”
Read more about the group’s findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.