Patients in the Radiology Department May Be at an Increased Risk of Developing Critical Instability

• Hour for hour, patients were more likely to experience instability requiring a medical emergency team call while in the radiology department (RD) compared with while on a hospital ward.
• The same level of monitoring and clinical care should be provided to patients in the RD as they receive on the clinical unit.
• Radiology should be considered a continuation of patient care, not an interruption in patient care.
• Clinicians sending patients to the RD for magnetic resonance imaging, nuclear medicine, or computed tomography should recognize that those patients are at increased risk for developing instability.
• Radiology nurses should establish a plan for patient surveillance and care to improve patient safety.

The purpose of this study was to calculate the event rate for inpatients in the radiology department (RD) developing instability leading to calls for medical emergency team (MET) assistance (MET-RD) compared with general ward (MET-W) patients. A retrospective comparison was done of MET-RD and MET-W calls in 2009 in a US tertiary hospital with a well-established MET system. MET-RD and MET-W event rates represented as MET calls/hr/1,000 admissions, adjusted for length of stay (LOS); rates also calculated for RD modalities. There were 31,320 hospital ward admissions that had 1,230 MET-Ws, and among 149,569 radiology admissions there were 56 MET-RDs. When adjusted for LOS, the MET-RD event rate was two times higher than the MET-W rate (0.48 vs. 0.24 events/hr/1,000 admissions). Event rates differed by procedure: computed tomography (CT) had 38% of MET-RDs (event rate, 0.89), and magnetic resonance imaging (MRI) accounted for 27% of MET-RDs (event rate, 1.56). Nuclear medicine had 1% of RD admissions, but these patients accounted for 5% of MET-RD (event rate, 1.53). Interventional radiology (IR) had 6% of RD admissions but 16% of MET-RD admissions (event rate, 0.61). Although general X-ray comprised 63% of RD admissions, only 11% of MET-RD involved their care (event rate, 0.09). In conclusion, the overall MET-RD event rate was twice the MET-W event rate; CT, MRI, and IR rates were 3.7 to 6.5 times higher than on wards. RD patients are at increased risk for an MET call compared with ward patients when the time at risk is considered. Increased surveillance of RD patients is warranted.