title: Quality assurance peer review chart rounds in 2011: a survey of academic institutions in the United States.
abstract: OBJECTIVE
  In light of concerns regarding the quality of radiation treatment delivery, we surveyed the practice of quality assurance peer review chart rounds at American academic institutions.
  
  
  METHODS
  An anonymous web-based survey was sent to the chief resident of each institution across the United States.
  
  
  RESULTS
  The response rate was 80% (57/71). The median amount of time spent per patient was 2.7 minutes (range, 0.6-14.4). The mean attendance by senior physicians and residents was 73% and 93%, respectively. A physicist was consistently present at peer review rounds in 66% of departments. There was a close association between attendance by senior physicians and departmental organization: in departments with protected time policies, good attendance was 81% vs. 31% without protected time (p = 0.001), and in departments that documented attendance, attending presence was 69% vs. 29% in departments without documentation (p < 0.05). More than 80% of institutions peer review all external beam therapy courses; however, rates were much lower for other modalities (radiosurgery 58%, brachytherapy 40%-47%). Patient history, chart documentation, and dose prescription were always peer reviewed in >75% of institutions, whereas dosimetric details (beams, wedges), isodose coverage, intensity-modulated radiation therapy constraints, and dose-volume histograms were always peer reviewed in 63%, 59%, 42%, and 50% of cases, respectively. Chart rounds led to both minor (defined as a small multileaf collimator change/repeated port film) and major (change to dose prescription or replan with dosimetry) treatment changes. Whereas at the majority of institutions changes were rare (<10% of cases), 39% and 11% of institutions reported that minor and major changes, respectively, were made to more than 10% of cases.
  
  
  CONCLUSIONS
  The implementation of peer review chart rounds seems inconsistent across American academic institutions. Brachytherapy and radiosurgical procedures are rarely reviewed. Attendance by senior physicians is variable, but it improves when scheduling clashes are avoided. The potential effect of a more thorough quality assurance peer review on patient outcomes is not known.
authors.affiliation: Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA. yaacovla@gmail.com
authors.forename: Yaacov Richard
authors.initials: YR
authors.lastname: Lawrence
authors.forename: Michal A
authors.initials: MA
authors.lastname: Whiton
authors.forename: Zvi
authors.initials: Z
authors.lastname: Symon
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Wuthrick
authors.forename: Laura
authors.initials: L
authors.lastname: Doyle
authors.forename: Amy S
authors.initials: AS
authors.lastname: Harrison
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dicker
mesh_terms: D000047:Academies and Institutes / Q000592:standards / Q000706:statistics & numerical data; D001918:Brachytherapy / Q000592:standards / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006283:Health Physics / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D018024:Peer Review, Health Care / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D018787:Radiation Oncology / Q000592:standards / Q000706:statistics & numerical data; D016634:Radiosurgery / Q000592:standards / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000592:standards* / Q000706:statistics & numerical data; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards / Q000706:statistics & numerical data; D014481:United States