A Robust Structure For Quality And Safety In A Large Academic Radiation Oncology Practice

Quality and safety programs (QSP) are critical to ensure zero patient harm and are a cornerstone for high reliability organizations. The purpose of this study is to assess the strength and structure of a QSP in a large academic radiation oncology practice. Beginning in July 2016, a new electronic incident learning system (ILS) was implemented for reporting safety concerns in our large, radiation oncology practice, comprised of a primary institution plus 6 campuses including a proton center, with 889 employees, including 65 fully credentialed radiation oncologists, 7 newly on-boarded radiation oncologists, 78 medical physicists, 60 nurses, 47 medical dosimetrists, 105 radiation therapists, and 21 advanced practice providers. We also initiated an electronic system for capturing quality assurance peer review of all radiation treatment plans, including single-fraction radiosurgery, boosts, and palliative treatments. Here we review the safety reporting and quality outcomes of our large department for fiscal year 2017 (FY17 – Sept 2016-Aug 2017) using descriptive analyses. A total of 9,124 new patients were treated with a total of 171,500 external beam radiation treatments in FY17. More than 1,800 reports were submitted through the ILS during FY17. There were no level 1 (state reportable) events, three level 2 events, 132 level 3 events, and 1,667 level 4 (near miss) events. The level 2 events were further investigated, including two formal root cause analyses. The most commonly reported issues were scheduling errors caused by Radiation Oncology (10%), ineffective communication (6%), and record and verify concerns identified at time of medical physics initial plan review (5%). A total of 9,653 patient radiation treatment plans were evaluated as part of the quality assurance peer review process, of which less than 1% (n=82) had major revision recommended, 3% (n=299) had minor changes suggested and 7% (n=711) were approved with discussion. Based on analysis of the ILS reports in FY17, communication and scheduling remain challenging areas for our practice and will be the focus for improvement in FY18. The success of our quality assurance peer review process exceeds the requirements of radiation oncology accreditation bodies in the Unites States and serves as a model for other radiation oncology practices.