June 24, 2011 | | Comments 1
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Not quite animal magnetism

Recently I fielded a question from someone who was reviewing an MRI safety plan and was curious about how the four-zone “defense” would work when the MRI is in a self-contained trailer that is not part of the building. Now my first thought on this was whether the MRI service is provided under contract (including staffing) or whether the service was staffed by hospital folks and the trailer under some kind of lease arrangement. My somewhat snotty response would have been to lean on the contract folks to work out how it all fits together, but then I was thinking: What if we had to work it out on our own, for whatever reason?

At first blush, I can see establishing three zones without too much difficulty. It may be necessary to combine Zones 2 and 3, but Zone 1 (i.e., general public) would be outside the trailer and Zone 4 (i.e., screened MRI patients under constant direct supervision of trained MRI personnel) would be in the magnet room, so that’s pretty reasonable. But again, what about Zones 2 (i.e., unscreened MRI patients) and Zone 3 (i.e., screened MRI patients and personnel)? I don’t think there would be enough room in the trailer for screened and unscreened folks, but maybe Zone 1 could be the ground level outside the trailer, Zone 2 could be the area just outside the trailer (on the lift and/or stairs—depends on the configuration of the trailer), which would leave Zone 3 in the control area.

Or I suppose you could do a risk assessment to demonstrate that the risks can be appropriately and reliably managed without adoption of the four-zone setup, but one would need to make sure that all staff in the area (and I do mean “all” staff) can speak to the protection measures in place. Querying of staff has been coming up in recent TJC surveys and if staff cannot speak to the zones and differing levels of safety/protection, it results in citations under the management of hazardous energy sources element of the Hazardous Materials and Waste Management standard. Probably not a bad thing to check on after lunch this afternoon.

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Steve MacArthur About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at stevemacsafetyspace@gmail.com.

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  1. Right you are, Steve! Don’t think for one second that simply because the MRI comes in a trailer that said trailer is also going to contain all of your MRI safety protections. One need look no further that TJC EC 02.01.01 to realize that it’s incumbent on the accredited provider to do a risk analysis of this service. With respect to zones, that means coordinating who provides which zones (I through IV), the hospital or the mobile provider.

    Frankly, in most mobile setups, true 4-zone isn’t possible. The best adaptation, then, is to provide Zones I and II in the hospital, and Zones III (control room) and IV (MRI scanner room) in the trailer. To help assure safety, however, the tech running the mobile MRI needs to review the screening (both clinical and physical) for everyone who may enter the MRI scanner room.

    I have worked on designs where the hospital provided Zone I – III functions, and the patient passed through a secured door from the hospital right in front of the mobile trailer entrance. With appropriate planning and design, you *can* have a true 4-zone with a mobile trailer, but it doesn’t happen automatically just by calling up the mobile provider and having them show up on Thursdays and Fridays.

    There’s been an increasing amount of heat applied to TJC with regard to radiology safety, and that includes MRI facilities. That probably translates to increased scrutiny of things like 4-zone set-ups for MRI suites. For those with mobiles, this is more than a little bit more complicated.

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