Protecting the sonographer

When discussing how best to protect the sonographer, there are two key focus areas: medico-legal issues and professional occupational health and safety. Ian Schroen, ASA President, and Kerry MacManus, Berkley Insurance Australia, share their views on how to promote better and safer practices for sonographers in the future, while also addressing the need to protect their mental health amid burnout and increasing workplace demands.

Kerry McManus

Senior Claims Adjuster | Berkley Insurance Australia

Kerry is a legally qualified insurance professional specialising in medical malpractice and professional indemnity, with experience in claims both nationally and internationally. She started her career in a private litigation practice in Ireland before moving to Australia and taking up a claims role in a niche allied health insurer. Kerry has since moved on to work with a major international insurer where she managed a portfolio of high profile, blue-chip clients, including private hospitals. Her current role at Berkley Insurance Australia sees her managing a varied portfolio, including significant claims for health professionals, lawyers and accountants.

What potential legal risks do sonographers face?

There are many risks sonographers may face, as with any profession, but not all risks automatically result in legal proceedings. Although sonographers generally work under the direction of a radiologist in a clinical or hospital setting and carry out procedures in accordance with a specific referral, they still have an individual responsibility to their patients to carry out their work with due care and skill.

While we can’t provide an exhaustive list of potential exposures, some examples include:

• clinical risks, such as errors in imaging, resulting in a missed diagnosis of cancerous lesions, or missed opportunities to identify abnormalities during morphology or obstetric scans

• practical risks, such as failing to take appropriate steps to identify fall hazards, resulting in falls from the treatment table

• communication risks, such as failing to obtain informed consent before a procedure or examination

• information risks arising from breaches of confidentiality.

Have you noticed any trends in sonographer related lawsuits?

The main areas we see activity in are the areas of clinical risks resulting in misdiagnosis or delayed diagnosis, and communication risks relating to informed consent and miscommunication. However, it is important to remember that an allegation does not always result in legal proceedings.

If a circumstance arises that calls into question the integrity, skill or professionalism of the sonographer, regardless of whether it results in a claim, it can be an incredibly worrying and stressful time for that individual and it is important to notify professional insurers without delay.

Building that rapport and communicating openly and effectively can assist in minimising the risk of a claim or complaint.

How can sonographers best protect themselves from being listed in a complaint?

There is no guaranteed way to wholly prevent a claim or complaint being brought, and it all comes down to individual circumstances. There are, however, some ways to potentially mitigate or reduce the chances:

One area we see claims or complaints arising is actual or perceived miscommunication. In these circumstances, the rapport that the sonographer builds with the patient is important. Building that rapport and communicating openly and effectively can assist in minimising the risk of a claim or complaint.

Accurately document communications and actions in sufficient detail so that others can read and understand what was said, what was done and why it is not only a requirement for medical records but can greatly assist if a claim or complaint is made. Good records can prevent issues arising from a misunderstanding. It is also more difficult to defend something without contemporaneous records.

A more obvious preventive step is to make sure that imaging is as accurate and clear as possible and if there are issues compromising this, for example, body mass, to specifically note the limitations experienced so that the referring doctor is aware of the problem.

Mistakes do happen, and unintentional errors can occur despite best efforts. One way to protect a sonographer in the event they are named as a defendant in legal proceedings is to ensure up-to-date professional indemnity insurance is in place.

If an individual practitioner has a concern regarding a particular situation, they should seek professional and legal advice as soon as possible and notify their professional indemnity insurers.

Patient consent is a complex issue. What resources would help sonographers navigate a patient consent form/policy?

The primary responsibility for the consent process in relation to the referral rests initially with the referring clinician. A sonographer should give appropriate weight to the referring clinician’s instructions, but sonographers should also keep in mind their own obligations.

A good starting point for sonographers is to become familiar with the employer, clinic, or hospital’s own written protocols and procedures, and ensure these guidelines are always followed during examinations and procedures. If any gaps are found, the sonographer should raise concerns and provide solutions, prioritising patient safety.

The Code of Conduct is a vital resource, as is staying up to date with continuing professional development, knowing the landscape is always evolving.

If available, suitable chaperones can be a really good resource too, providing the sonographer and the patient with a sense of safety and support. It can help minimise the risk of confusion as to consent at the outset of the scan and throughout the scan. The patient should, however, always consent to the presence of a chaperone and should be comfortable with the selected chaperone.

The offer of a support person during an examination can be useful – for example, a family member, a friend or a legal guardian, someone whom the patient may feel more comfortable with, and/or who can speak up on behalf of the patient, if necessary, and particularly if the sonographer misses a patient’s nonverbal cues.

Ian Schroen

President | Australasian Sonographers Association

Ian’s career to date has been diverse, challenging and centred around ultrasound. Ian first gained a passion for vascular ultrasound during the 1990s, and after several years in clinical ultrasound, he moved to a corporate role. Well known for his work at Philips Healthcare, Ian returned to clinical ultrasound and completed a Master of Medical Ultrasound, and continues to be engaged in clinical ultrasound, research and teaching opportunities. Ian regularly presents in various forums across a range of clinical and nonclinical topics and is the current president of the Australasian Sonographers Association.

How can sonographers protect themselves against burnout and mental health-related issues?

Sonographers can take several steps to protect themselves against burnout and mental health-related issues, including:

• looking after yourself – especially after the stresses of the past few years. Sonographers should prioritise basic healthy habits, such as getting enough sleep, maintaining a balanced diet, and engaging in regular physical activity to improve overall wellbeing

• managing your workload – try to maintain a reasonable workload. If you’re feeling overwhelmed, communicate with supervisors or employers. Also, ensure appropriate work/life balance without excessive overtime or on-call commitments

• sharing and connecting – connect with colleagues and seek peer support. Sharing experiences and challenges can help reduce feelings of isolation and stress. Don’t hesitate to get professional help through your employer’s Employee Assistance Program (EAP)

• maintaining learning – stay up to date with sonography changes and advancements through continuing professional development (CPD) programs. Feeling competent in your role can reduce stress and increase job satisfaction.

What is the significance of employers in advocating for, aiding, and upholding a state of positive mental wellbeing among their employees?

Employers play a really important role in advocating for and upholding the positive mental wellbeing of their sonographer employees. They can offer leadership and support through:

• mental health support programs – employers can offer mental health programs, workshops, or access to counselling services to support their employees’ mental wellbeing

• work/life balance – encourage and support a healthy work/ life balance. Promote flexible work rostering and reasonable workload

• communication – foster open communication between management and employees. Encourage employees to voice concerns, and actively listen and respond to their needs

• training and education – provide training on stress management, resilience, and mental health awareness. This can help employees recognise signs of burnout and seek help when needed

• safe work environment – ensure equipment is in good working order and safety protocols are followed to reduce the risk of work-related injuries

• recognition and appreciation – acknowledge and reward employees for their hard work and dedication. Feeling appreciated boosts morale and workplace enjoyment.

Sharing experiences and challenges can help reduce feelings of isolation and stress.

Work-related injury is at an all-time high. What can we as a profession do to combat this?

To decrease work-related injuries in the sonography profession, some key initiatives could include:

• stretching and injury prevention – incorporating stretching into the daily routine of sonographers is a proactive measure that not only safeguards their physical health but contributes to job longevity and effectiveness in this demanding profession

• ergonomics – promote proper ergonomic practices to reduce the risk of musculoskeletal injuries. Provide ergonomic equipment and training to sonographers

• mini breaks – long ultrasound exams can require sonographers to maintain fixed positions and perform repetitive motions for extended periods, which can lead to fatigue, discomfort, and increased risk of musculoskeletal injuries. Mini breaks involve briefly stepping away from the ultrasound machine, changing positions, and performing light stretches or movements

• reporting and investigation – encourage reporting of all workplace injuries and near-miss incidents. Investigate the causes and implement corrective measures to prevent future occurrences

• education and training – continuously educate sonographers about the potential risks associated with their work and train them on injury prevention techniques.

There is a current trend of scan times decreasing. Where should the line be drawn to avoid professional exhaustion across the industry?

To address the trend of decreasing scan times, and avoid professional exhaustion across the industry, there are a number of strategies employers can implement, including:

• setting realistic expectations – employers should set realistic expectations for scan times that prioritise patient safety and image quality over speed

• ensuring quality over quantity – emphasise the importance of producing high quality diagnostic images even if it takes slightly longer. Quality should never be sacrificed for speed

• ensuring workflow optimisation – invest in technologies and workflow optimisation techniques that can help streamline the scanning process without compromising quality

• ensuring regular breaks – encourage sonographers to take regular breaks to rest and recharge during shifts, especially if they have a high workload

• protecting staffing levels – ensure adequate staffing levels to distribute the workload evenly and prevent individual sonographers from becoming overwhelmed

• introducing feedback mechanisms – establish feedback mechanisms for sonographers to communicate concerns about scan times and workload to management

• promoting continuing education – provide opportunities for sonographers to further their education and skills, which can lead to increased efficiency without compromising quality.

Balancing efficiency and quality are essential in the field of sonography to ensure both patient care and the wellbeing of sonographers. Employers should prioritise the health and professional satisfaction of their sonographer workforce. •