Modern palliative radiation treatment: do complexity and workload contribute to medical errors?
OBJECTIVE
To examine whether treatment workload and complexity associated with palliative radiation therapy contribute to medical errors.


METHODS
In the setting of a large academic health sciences center, patient scheduling and record and verification systems were used to identify patients starting radiation therapy. All records of radiation treatment courses delivered during a 3-month period were retrieved and divided into radical and palliative intent. "Same day consultation, planning and treatment" was used as a proxy for workload and "previous treatment" and "multiple sites" as surrogates for complexity. In addition, all planning and treatment discrepancies (errors and "near-misses") recorded during the same time frame were reviewed and analyzed.


RESULTS
There were 365 new patients treated with 485 courses of palliative radiation therapy. Of those patients, 128 (35%) were same-day consultation, simulation, and treatment patients; 166 (45%) patients had previous treatment; and 94 (26%) patients had treatment to multiple sites. Four near-misses and 4 errors occurred during the audit period, giving an error per course rate of 0.82%. In comparison, there were 10 near-misses and 5 errors associated with 1100 courses of radical treatment during the audit period. This translated into an error rate of 0.45% per course. An association was found between workload and complexity and increased palliative therapy error rates.


CONCLUSIONS
Increased complexity and workload may have an impact on palliative radiation treatment discrepancies. This information may help guide the necessary recommendations for process improvement for patients who require palliative radiation therapy.
Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. neil.dsouza@sunnybrook.ca
Neil
N
D'Souza
Lori
L
Holden
Sheila
S
Robson
Kathy
K
Mah
Lisa
L
Di Prospero
C Shun
CS
Wong
Edward
E
Chow
Jacqueline
J
Spayne
D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data*; D009864:Ontario; D010166:Palliative Care / Q000706:statistics & numerical data*; D058996:Quality Improvement; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000009:adverse effects / Q000706:statistics & numerical data; D016526:Workload / Q000706:statistics & numerical data*