ESTRO 36 Abstract Book

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S559 ESTRO 36 2017
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PO-1021 An electronically configurable checklist
program for quality control of RT treatment planning
K.H. Grosser1, A.C. Schulte1, W. Harms1
1 St. Claraspital, Radiooncology, Basel, Switzerland
Purpose or Objective
To asses efficacy of an adaptive checklist program to
facilitate plan review for physicists.
Material and Methods
Pre-treatment plan review is fundamentally important to
patient safety and treatment plan quality. A critical
control point in this process is the ‘Planning Approval‘
process. To reduce the error rate we developed an
adaptive electronical planning approval checklist as part
of our quality assurance. We applied this program to more
than 600 treatment plans produced with the Eclipse
treatment planning system (VARIAN). Because we wanted
to optimize the checklist continuously the program was set
up to be adaptive with respect to the plan type and to
allow the addition of new checklist items. All evaluated
cases were documented in a database. The incidence rates
of errors and their types are reported.
Results
The checklist program was introduced into clinical routine
in October 2012 and was used in this version until the end
of 2015.
In total 638 plans were checked. With the help of this
checklist program 303 errors in 190 treatment planes
were detected. Most errors were classified as minor errors
(i.e. incorrect target volume nomenclature). However, 29
dose-related errors have also been found.
13 new checklist items have been gradually added to the
existing checklist to account for newly detected error
possibilities.
The average time to complete the checklist was
approximately 3 minutes. The compliance rate was very
high. As expected, the acceptance of the “Do-Confirm”
strategy was higher than for the “Read-Do” practice.
Conclusion
A planning approval checklist is a valuable tool to reduce
the error rate of treatment plan validation to almost zero.
An automated or semi-automated checklist tool with
direct access to the database of the treatment planning
system would be desirable.
PO-1022 Implementation of a paperless workflow in
radiotherapy; Reducing transcription
O. Shoffren1, Y. Tsang1, J. Kudhail1
1 Mount Vernon Cancer Centre, Radiotherapy
Department, borehamwood, United Kingdom
Purpose or Objective
It is well recognised that due to the complexities of the
radiotherapy pathway transcription errors are common. As
such robust processes are in place throughout the
treatment pathway to ensure checking processes are fit
for purpose.
With the importance on using source data to eliminate this
potential for transcription errors to arise, our centre has
adopted a paperless workflow allowing access to source
data ; from referral to the last fraction of radiotherapy.
The aim of the study was to evaluate the effectiveness of
the new workflow in terms of reducing errors.
Material and Methods
Since April 2016, a paperless workflow has been
introduced for each area of the pathway including;
referral, data capture at CT, planning information and
treatment information up to the last fraction. A focus
group was formed to investigate the options available for
recording the required information at all stages. These
included using an electronic referral and booking form,
dynamic documents for recording treatment setup details,
electronic journals for recording actions and histories
throughout the treatment and toxicity scoring. All checks
required on before, during and after treatments were
assigned as tasks or checklists and these were made into a
standardised automated protocol.All errors at our centre
are recorded electronically on a centralised incidence
reporting system. The numbers of error occurrences that
happened 3 months before and after the introduction of
the process were analysed.
Results
In total, there were 51 and 49 radiotherapy related
incidents recorded before and after the introduction of
the paperless workflow respectively. The number of
incidents related to transcription errors decreased from
29% (15/51) to 16% (8/49) since the paperless change. It’s
noted that there was a small rise in reported incidences in
other areas of the pathway due to a change in work
procedure.
Conclusion
It’s suggested the number of transcription errors was
minimised through the adoption of the paperless
workflow. It’s also proved to be beneficial to have a
centralised electronic incident reporting system to
monitor and review incidents in a radiotherapy
department, in order to streamline and optimise existing
patient pathways.
PO-1023 Reducing waiting room times - A 5 year
review of an in-house KPI tool
A. Wallis1, D. Moretti1
1Liverpool Hospital, Radiation Oncology, Liverpool,
Australia
Purpose or Objective
Patient waiting times has a significant impact in a
patient’s overall satisfaction of their healthcare
experience (1). The main contributors to patient waiting
times are inadequate appointment duration, staff
experience level, patient late arrival and machine
breakdowns (1). Literature on radiation oncology
productivity is dominated by variation and validation of
the basic treatment equivalent (BTE) model (2). However,
the technological advancements in imaging and treatment
modalities such as intensity modulated radiation therapy
(IMRT), image guided radiotherapy (IGRT), volumetric RT
(VMAT) and Tomotherapy have changed the landscape of
RT and its productivity measures (4).
In 2011, the management team at Liverpool and
Macarthur Cancer Therapy Centres (LMCTC) introduced an
in-house key performance indicator (KPI) tool to measure
the performance of the treatment machines. The catalyst
for the design and implementation of the tool was the
introduction of the New South Wales (NSW) Performance
Measures report of 2010 (3). The main objective of the
tool was to capture each individual patient's appointment
time to ensure adequate and individualised patient
appointment scheduling. It was hypothesised that the
introduction of this tool would reduce the waiting room
time for patients.
Material and Methods
In 2010, Mosaiq 2.0X was installed in LMCTC. This version
allowed the extraction of time stamps in a reporting tool
(Crystal reports version 11). Standardisation of the
treatment processes improved the robustness of patient
data and allowed accurate extraction of time stamps in
Mosaiq. This data were then imported into Microsoft Excel
on a weekly basis for visual display of the KPIs. The tool
was launched in October of 2010 for a trial period of two
months and has been in use in the department since its
introduction.
Results
During the period of October to December 2010, the
department recorded that 56% of patients were treated on
time. Since the tool was introduced and actioned in 2011,
the department has recorded an average of 71.2% (range
69-76%) of patients treated on time. These results are
encouraging considering the number of attendances to the
department has increased over the 5 year period (Fig 1).