title: Incident Learning and Failure-Mode-and-Effects-Analysis Guided Safety Initiatives in Radiation Medicine.
abstract: By combining incident learning and process failure-mode-and-effects-analysis (FMEA) in a structure-process-outcome framework we have created a risk profile for our radiation medicine practice and implemented evidence-based risk-mitigation initiatives focused on patient safety. Based on reactive reviews of incidents reported in our departmental incident-reporting system and proactive FMEA, high safety-risk procedures in our paperless radiation medicine process and latent risk factors were identified. Six initiatives aimed at the mitigation of associated severity, likelihood-of-occurrence, and detectability risks were implemented. These were the standardization of care pathways and toxicity grading, pre-treatment-planning peer review, a policy to thwart delay-rushed processes, an electronic whiteboard to enhance coordination, and the use of six sigma metrics to monitor operational efficiencies. The effectiveness of these initiatives over a 3-years period was assessed using process and outcome specific metrics within the framework of the department structure. There has been a 47% increase in incident-reporting, with no increase in adverse events. Care pathways have been used with greater than 97% clinical compliance rate. The implementation of peer review prior to treatment-planning and use of the whiteboard have provided opportunities for proactive detection and correction of errors. There has been a twofold drop in the occurrence of high-risk procedural delays. Patient treatment start delays are routinely enforced on cases that would have historically been rushed. Z-scores for high-risk procedures have steadily improved from 1.78 to 2.35. The initiatives resulted in sustained reductions of failure-mode risks as measured by a set of evidence-based metrics over a 3-years period. These augment or incorporate many of the published recommendations for patient safety in radiation medicine by translating them to clinical practice.
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kapur
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Goode
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Riehl
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Petrina
authors.initials: P
authors.lastname: Zuvic
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Sherin
authors.initials: S
authors.lastname: Joseph
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Nilda
authors.initials: N
authors.lastname: Adair
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Interrante
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Bloom
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Lucille
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Anurag
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Antone
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Riegel
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Lili
authors.initials: L
authors.lastname: Vijeh
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Honglai
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Yijian
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Morgenstern
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Montchal
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Cox
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine , New Hyde Park, NY , USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Potters
keywords: electronic whiteboard; failure-mode-and-effects-analysis; incident learning; no-fly-policy; patient safety; root cause analysis; six sigma