The Silent Epidemic of Iatrogenic Harm: A Review of Systemic Vulnerabilities Across the Medication and Medical Imaging Chain
Abstract
Background: Iatrogenic harm, originating from healthcare processes themselves, constitutes a pervasive and often silent epidemic. Medication and diagnostic imaging errors represent two major, frequently siloed categories of preventable patient harm, embedded within complex, interdependent clinical systems. A systems safety perspective is essential to understand their interconnected nature.
Aim: This narrative review aims to synthesize evidence on the systemic vulnerabilities linking medication and medical imaging safety chains. It examines points of failure across professions—Pharmacy, Nursing, Diagnostic Radiology, Laboratory, Medical Devices Technology, Medical Secretaries, and Hospital Administration—to identify shared root causes and integrated solutions.
Methods: A comprehensive search of PubMed, CINAHL, Scopus, and Web of Science (2010-2024) was conducted using keywords related to medication errors, diagnostic errors, systems safety, and interprofessional collaboration. Literature was analyzed thematically to map the error pathways and systemic interdependencies.
Results: The review identifies recurrent, cross-cutting vulnerabilities: flawed communication handoffs, human-device interfaces prone to misuse, conflicting administrative priorities, and inadequate interprofessional checkpoints. Errors in one domain (e.g., a radiology contrast protocol) directly propagate to another (e.g., pharmacy-dispensed pre-medication). Latent system failures often precede active errors by frontline staff.
Conclusion: Medication and imaging safety are inextricably linked. Mitigating harm requires transcending professional silos through integrated, system-wide protocols that address shared root causes, foster a culture of collective accountability, and redesign workflows with inherent safety.
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References
Alexander, R., Waite, S., Bruno, M. A., Krupinski, E. A., Berlin, L., Macknik, S., & Martinez-Conde, S. (2022). Mandating limits on workload, duty, and speed in radiology. Radiology, 304(2), 274-282. https://doi.org/10.1148/radiol.212631
Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ open, 8(5), e019101.
Bruno, M. A., Walker, E. A., & Abujudeh, H. H. (2015). Understanding and confronting our mistakes: the epidemiology of error in radiology and strategies for error reduction. Radiographics, 35(6), 1668-1676. https://doi.org/10.1148/rg.2015150023
Cashion, W., & Weisbord, S. D. (2022). Radiographic contrast media and the kidney. Clinical Journal of the American Society of Nephrology, 17(8), 1234-1242. DOI: 10.2215/CJN.16311221
Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., ... & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668. https://doi.org/10.1148/radiol.2019192094
de Laforcade, L., Bobot, M., Bellin, M. F., Clement, O., Grange, S., Grenier, N., ... & Guerrot, D. (2021). Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagnostic and Interventional Imaging, 102(3), 131-139. https://doi.org/10.1016/j.diii.2021.01.007
Härkänen, M., Haatainen, K., Vehviläinen-Julkunen, K., & Miettinen, M. (2021). Artificial intelligence for identifying the prevention of medication incidents causing serious or moderate harm: an analysis using incident reporters’ views. International journal of environmental research and public health, 18(17), 9206. https://doi.org/10.3390/ijerph18179206
Hegde, S., Gao, J., Vasa, R., & Cox, S. (2023). Factors affecting interpretation of dental radiographs. Dentomaxillofacial Radiology, 52(2), 20220279. https://doi.org/10.1259/dmfr.20220279
Hussien, A. R., Abdellatif, W., Siddique, Z., Mirchia, K., El-Quadi, M., & Hussain, A. (2022). Diagnostic errors in neuroradiology: a message to emergency radiologists and trainees. Canadian Association of Radiologists Journal, 73(2), 384-395. https://doi.org/10.1177/08465371211025738
Kuitunen, S., Niittynen, I., Airaksinen, M., & Holmström, A. R. (2021). Systemic causes of in-hospital intravenous medication errors: a systematic review. Journal of Patient Safety, 17(8), e1660-e1668. DOI: 10.1097/PTS.0000000000000632
Marzal-Alfaro, M. B., Escudero-Vilaplana, V., Revuelta-Herrero, J. L., Collado-Borrell, R., Herranz-Alonso, A., & Sanjurjo-Saez, M. (2021). Chimeric antigen receptor T cell therapy management and safety: a practical tool from a multidisciplinary team perspective. Frontiers in oncology, 11, 636068. https://doi.org/10.3389/fonc.2021.636068
Marznaki, Z. H., Zeydi, A. E., Ghazanfari, M. J., Salisu, W. J., Amiri, M. M., & Karkhah, S. (2023). Medication errors among Iranian intensive care nurses: a systematic review. Iranian Journal of Nursing and Midwifery Research, 28(2), 123-131. DOI: 10.4103/ijnmr.ijnmr_310_21
McDonald, J. S., McDonald, R. J., Carter, R. E., Katzberg, R. W., Kallmes, D. F., & Williamson, E. E. (2014). Risk of intravenous contrast material–mediated acute kidney injury: a propensity score–matched study stratified by baseline-estimated glomerular filtration rate. Radiology, 271(1), 65-73. https://doi.org/10.1148/radiol.13130775
Mijwil, M. M., Al-Mistarehi, A. H., Abotaleb, M., El-Kenawy, E. S. M., Ibrahim, A., Abdelhamid, A. A., & Eid, M. M. (2023). From pixels to diagnoses: deep learning's impact on medical image processing-a survey. Wasit Journal of Computer and Mathematics Science, 2(3), 9-15. https://doi.org/10.31185/wjcms.178
Moll, G., Ankrum, J. A., Olson, S. D., & Nolta, J. A. (2022). Improved MSC minimal criteria to maximize patient safety: a call to embrace tissue factor and hemocompatibility assessment of MSC products. Stem cells translational medicine, 11(1), 2-13. https://doi.org/10.1093/stcltm/szab005
Moyer, B. R., Cheruvu, N. P., & Hu, T. C. C. (Eds.). (2013). Pharmaco-imaging in drug and biologics development: fundamentals and applications (Vol. 8). Springer Science & Business Media.
Newman-Toker, D. E., Wang, Z., Zhu, Y., Nassery, N., Tehrani, A. S. S., Schaffer, A. C., ... & Siegal, D. (2021). Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”. Diagnosis, 8(1), 67-84. https://doi.org/10.1515/dx-2019-0104
Orlacchio, A., Guastoni, C., Beretta, G. D., Cosmai, L., Galluzzo, M., Gori, S., ... & Casinelli, A. (2022). SIRM-SIN-AIOM: Appropriateness criteria for evaluation and prevention of renal damage in the patient undergoing contrast medium examinations—Consensus statements from Italian College of Radiology (SIRM), Italian College of Nephrology (SIN) and Italian Association of Medical Oncology (AIOM). La radiologia medica, 127(5), 534-542. https://doi.org/10.1007/s11547-022-01483-8
Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., ... & Ashcroft, D. M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. bmj, 366. https://doi.org/10.1136/bmj.l4185
Pierre, K., Haneberg, A. G., Kwak, S., Peters, K. R., Hochhegger, B., Sananmuang, T., ... & Forghani, R. (2023, April). Applications of artificial intelligence in the radiology roundtrip: process streamlining, workflow optimization, and beyond. In Seminars in Roentgenology (Vol. 58, No. 2, pp. 158-169). WB Saunders. https://doi.org/10.1053/j.ro.2023.02.003
Sarkar, A., Aggarwal, A., Grigoryan, L., Nash, S. G., Mehrotra, N., Zoorob, R. J., & Huang, W. Y. (2021). Improving student confidence with electronic health record order entry. PRiMER: Peer-Review Reports in Medical Education Research, 5, 23. https://doi.org/10.22454/PRiMER.2021.619838
Shamim, M. M. R. (2022). Electrical And Mechanical Troubleshooting in Medical And Diagnostic Device Manufacturing: A Systematic Review Of Industry Safety And Performance Protocols. American Journal of Scholarly Research and Innovation, 1(01), 295-318. https://doi.org/10.63125/d68y3590
Starmer, A. J., Schnock, K. O., Lyons, A., Hehn, R. S., Graham, D. A., Keohane, C., & Landrigan, C. P. (2017). Effects of the I-PASS Nursing Handoff Bundle on communication quality and workflow. BMJ quality & safety, 26(12), 949-957. https://doi.org/10.1136/bmjqs-2016-006224
Vanderzwan, K. J., Kilroy, S., Daniels, A., & O’Rourke, J. (2023). Nurse-to-nurse handoff with distractors and interruptions: An integrative review. Nurse Education in Practice, 67, 103550. https://doi.org/10.1016/j.nepr.2023.103550
Wack, M., Puymirat, E., Ranque, B., Georgin-Lavialle, S., Pierre, I., Tanguy, A., ... & Avillach, P. (2015). Evaluating the impact of computerized provider order entry on medical students training at bedside: a randomized controlled trial. PLoS One, 10(9), e0138094. https://doi.org/10.1371/journal.pone.0138094
Waite, S., Scott, J., Gale, B., Fuchs, T., Kolla, S., & Reede, D. (2017). Interpretive error in radiology. American Journal of Roentgenology, 208(4), 739-749.
Wang, W., Pang, J., Su, J., Li, F., Li, Q., Wang, X., ... & Cuniberti, G. (2022). Applications of nanogenerators for biomedical engineering and healthcare systems. InfoMat, 4(2), e12262. https://doi.org/10.1002/inf2.12262
Weinreb, J. C., Rodby, R. A., Yee, J., Wang, C. L., Fine, D., McDonald, R. J., ... & Davenport, M. S. (2021). Use of intravenous gadolinium-based contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 298(1), 28-35. https://doi.org/10.1148/radiol.2020202903
Westbrook, J. I., Li, L., Lehnbom, E. C., Baysari, M. T., Braithwaite, J., Burke, R., ... & Day, R. O. (2018). What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International Journal for Quality in Health Care, 30(2), 124-131.
Wilson, C. B., Slade, C., Wong, W. Y. A., & Peacock, A. (2020). Health care students experience of using digital technology in patient care: a scoping review of the literature. Nurse Education Today, 95, 104580. https://doi.org/10.1016/j.nedt.2020.104580
Zhang, L., Wen, X., Li, J. W., Jiang, X., Yang, X. F., & Li, M. (2023). Diagnostic error and bias in the department of radiology: a pictorial essay. Insights into Imaging, 14(1), 163. https://doi.org/10.1186/s13244-023-01521-7
Authors
Copyright (c) 2024 Hessah Hussein Alanazi, Fatimah Hussain Alshihab, Abdulaziz Ali Abdullah Al Muqrin, Bayan Mohammed Alqasimi, Ahmad Ali Arishi, Tamadoor Basher Omar Alfootiy, Nouf Nouh Alhawsawi, Ibrahim Menwer Almozaini, Samir Ayed Al-Samiri, Abdullah Yahya H. Oagde, Abdulhadi Mohammed Al-Amri, Mona Dakhilallah Alanazi
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