title: Eliminating inconsistencies in simulation and treatment planning orders in radiation therapy.
abstract: OBJECTIVE
  To identify deficiencies with simulation and treatment planning orders and to develop corrective measures to improve safety and quality.
  
  
  METHODS
  At Washington University, the DMAIIC formalism is used for process management, whereby the process is understood as comprising Define, Measure, Analyze, Improve, Implement, and Control activities. Two complementary tools were used to provide quantitative assessments: failure modes and effects analysis and reported event data. The events were classified by the user according to severity. The event rates (ie, number of events divided by the number of opportunities to generate an event) related to simulation and treatment plan orders were determined.
  
  
  RESULTS
  We analyzed event data from the period 2008-2009 to design an intelligent SIMulation and treatment PLanning Electronic (SIMPLE) order system. Before implementation of SIMPLE, event rates of 0.16 (420 of 2558) for a group of physicians that were subsequently used as a pilot group and 0.13 (787 of 6023) for all physicians were obtained. An interdisciplinary group evaluated and decided to replace the Microsoft Word-based form with a Web-based order system. This order system has mandatory fields and context-sensitive logic, an ability to create templates, and enables an automated process for communication of orders through an enterprise management system. After the implementation of the SIMPLE order, the event rate decreased to 0.09 (96 of 1001) for the pilot group and to 0.06 (145 of 2140) for all physicians (P<.0001). The average time to complete the SIMPLE form was 3 minutes, as compared with 7 minutes for the Word-based form. The number of severe events decreased from 10.7% (45 of 420) and 12.1% (96 of 787) to 6.2% (6 of 96) and 10.3% (15 of 145) for the pilot group and all physicians, respectively.
  
  
  CONCLUSIONS
  There was a dramatic reduction in the total and the number of potentially severe events through use of the SIMPLE system. In addition, the order process has become more efficient and reliable.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA. lsantanam@radonc.wustl.edu
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Santanam
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Brame
authors.forename: Andrew
authors.initials: A
authors.lastname: Lindsey
authors.forename: Todd
authors.initials: T
authors.lastname: Dewees
authors.forename: Jon
authors.initials: J
authors.lastname: Danieley
authors.forename: Jason
authors.initials: J
authors.lastname: Labrash
authors.forename: Parag
authors.initials: P
authors.lastname: Parikh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bradley
authors.forename: Imran
authors.initials: I
authors.lastname: Zoberi
authors.forename: Jeff
authors.initials: J
authors.lastname: Michalski
authors.forename: Sasa
authors.initials: S
authors.lastname: Mutic
mesh_terms: D003142:Communication; D004526:Efficiency; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D016347:Medical Records Systems, Computerized / Q000592:standards*; D061214:Patient Safety; D017064:Process Assessment, Health Care / Q000592:standards; D058996:Quality Improvement / Q000592:standards*; D011878:Radiotherapy / Q000009:adverse effects / Q000592:standards*; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards