[Intl_DxMedPhys] TJC and NQF update to Sentinel Events List

[William Sensakovic]

Now that there is a charge associated with safety it makes sense they would also want to ensure work is actually happening. Yes, I know this is not directly tied to the charge, but the timing is not surprising. Also, every place should already be doing rca and the other steps when there is patient injury regardless of cause so my guess is that they assume this is essentially a net 0 increase in work.

William F. Sensakovic, PhD, MRSC(MRSE), FAAPM
Chair and Assoc. Prof., Mayo Clinic (Arizona)
Founder, Telerad Physics Teaching, LLC
________________________________
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+wfsensak=outlook.com at lists.osu.edu> on behalf of Christina Brunnquell via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Sent: Wednesday, January 28, 2026 9:06:38 AM
To: Travis Greene <TGreene at radser.com>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: Re: [Intl_DxMedPhys] TJC and NQF update to Sentinel Events List

Wow, this is a really big change. Thanks for the heads up, Travis. Of course we work hard to minimize such events but in comparison to my mental benchmark of sentinel events (15 Gy PSD, which yes I know is no longer a SE, but it's still
Wow, this is a really big change. Thanks for the heads up, Travis. Of course we work hard to minimize such events but in comparison to my mental benchmark of sentinel events (15 Gy PSD, which yes I know is no longer a SE, but it's still my mental benchmark), these events are substantially more common. I'm interested in a gut check on other MR safety folks' thoughts/impressions, feel free to respond directly.
Christina

On Tue, Jan 27, 2026 at 9:17 AM Travis Greene via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
Colleagues, I came across this information in a social media post regarding MRI safety. The Joint Commission and National Quality Forum have released their January 2026 report, "Aligning Patient Safety Event Reporting: 2025 Updates to Sentinel

Colleagues,



I came across this information in a social media post regarding MRI safety.



The Joint Commission and National Quality Forum have released their January 2026 report, "Aligning Patient Safety Event Reporting: 2025 Updates to Sentinel Events and Serious Reportable Events".  The 2025 NQF SRE list now has 28 events in four categories, with 23 updated/modified from the 2011 list and several new additions.



TJC will adopt the updated SRE list into its SE list effective January 1, 2027, giving accredited organizations time to prepare. Reporting remains voluntary, but TJC expects accredited organizations to identify these events, perform root cause analysis, and implement improvements to prevent recurrence.  Of interest to us, SRE 5 and SRE 6 relate to MRI Safety.



  *   SRE 5: Introduction of an unapproved, unscreened, or inappropriately approved device, implant, or object into an MRI Zone IV.
  *   SRE 6: Patient harm associated with an MRI-related thermal injury.



For complete details, please see the attached report.  (2025 SE & SRE Report<https://urldefense.com/v3/__https://digitalassets.jointcommission.org/api/public/content/b4e8988066e74717ae9801edb2bfb9de?v=e0ff96a2__;!!KGKeukY!yHalqw2LntpjV0KyVuGkrIx9M19ApDNRf5WlfG9-YA39tx-gQrdMBS6DPaj_N0q48x8QVbdsH77WPg9EGUrrrebIsyENjjPVL27onA$>)



Travis


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