title: A comprehensive quality assurance program for personnel and procedures in radiation oncology: value of voluntary error reporting and checklists.
abstract: OBJECTIVE
  This report describes the value of a voluntary error reporting system and the impact of a series of quality assurance (QA) measures including checklists and timeouts on reported error rates in patients receiving radiation therapy.
  
  
  METHODS
  A voluntary error reporting system was instituted with the goal of recording errors, analyzing their clinical impact, and guiding the implementation of targeted QA measures. In response to errors committed in relation to treatment of the wrong patient, wrong treatment site, and wrong dose, a novel initiative involving the use of checklists and timeouts for all staff was implemented. The impact of these and other QA initiatives was analyzed.
  
  
  RESULTS
  From 2001 to 2011, a total of 256 errors in 139 patients after 284,810 external radiation treatments (0.09% per treatment) were recorded in our voluntary error database. The incidence of errors related to patient/tumor site, treatment planning/data transfer, and patient setup/treatment delivery was 9%, 40.2%, and 50.8%, respectively. The compliance rate for the checklists and timeouts initiative was 97% (P<.001). These and other QA measures resulted in a significant reduction in many categories of errors. The introduction of checklists and timeouts has been successful in eliminating errors related to wrong patient, wrong site, and wrong dose.
  
  
  CONCLUSIONS
  A comprehensive QA program that regularly monitors staff compliance together with a robust voluntary error reporting system can reduce or eliminate errors that could result in serious patient injury. We recommend the adoption of these relatively simple QA initiatives including the use of checklists and timeouts for all staff to improve the safety of patients undergoing radiation therapy in the modern era.
authors.affiliation: Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. j-kalapurakal@northwestern.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Kalapurakal
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Zafirovski
authors.forename: Jeffery
authors.initials: J
authors.lastname: Smith
authors.forename: Paul
authors.initials: P
authors.lastname: Fisher
authors.forename: Vythialingam
authors.initials: V
authors.lastname: Sathiaseelan
authors.forename: Cynthia
authors.initials: C
authors.lastname: Barnard
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.forename: Nick
authors.initials: N
authors.lastname: Rave
authors.forename: Bharat B
authors.initials: BB
authors.lastname: Mittal
mesh_terms: D057189:Checklist; D006801:Humans; D019300:Medical Errors / Q000145:classification / Q000517:prevention & control* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000473:pathology / Q000532:radiotherapy; D061214:Patient Safety; D011785:Quality Assurance, Health Care; D011786:Quality Control; D018787:Radiation Oncology / Q000592:standards* / Q000706:statistics & numerical data; D061106:Radiotherapy Setup Errors / Q000517:prevention & control; D014342:Truth Disclosure; D035141:Voluntary Programs / Q000458:organization & administration* / Q000706:statistics & numerical data