title: Quality Assurance with Plan Veto: reincarnation of a record and verify system and its potential value.
abstract: OBJECTIVE
  To quantify the potential impact of the Integrating the Healthcare Enterprise-Radiation Oncology Quality Assurance with Plan Veto (QAPV) on patient safety of external beam radiation therapy (RT) operations.
  
  
  METHODS
  An institutional database of events (errors and near-misses) was used to evaluate the ability of QAPV to prevent clinically observed events. We analyzed reported events that were related to Digital Imaging and Communications in Medicine RT plan parameter inconsistencies between the intended treatment (on the treatment planning system) and the delivered treatment (on the treatment machine). Critical Digital Imaging and Communications in Medicine RT plan parameters were identified. Each event was scored for importance using the Failure Mode and Effects Analysis methodology. Potential error occurrence (frequency) was derived according to the collected event data, along with the potential event severity, and the probability of detection with and without the theoretical implementation of the QAPV plan comparison check. Failure Mode and Effects Analysis Risk Priority Numbers (RPNs) with and without QAPV were compared to quantify the potential benefit of clinical implementation of QAPV.
  
  
  RESULTS
  The implementation of QAPV could reduce the RPN values for 15 of 22 (71%) of evaluated parameters, with an overall average reduction in RPN of 68 (range, 0-216). For the 6 high-risk parameters (>200), the average reduction in RPN value was 163 (range, 108-216). The RPN value reduction for the intermediate-risk (200 > RPN > 100) parameters was (0-140). With QAPV, the largest RPN value for "Beam Meterset" was reduced from 324 to 108. The maximum reduction in RPN value was for Beam Meterset (216, 66.7%), whereas the maximum percentage reduction was for Cumulative Meterset Weight (80, 88.9%).
  
  
  CONCLUSIONS
  This analysis quantifies the value of the Integrating the Healthcare Enterprise-Radiation Oncology QAPV implementation in clinical workflow. We demonstrate that although QAPV does not provide a comprehensive solution for error prevention in RT, it can have a significant impact on a subset of the most severe clinically observed events.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Camille E
authors.initials: CE
authors.lastname: Noel
authors.affiliation: Department of Radiation Oncology, Scott and White Healthcare, Temple, Texas.
authors.forename: Veerarajesh
authors.initials: V
authors.lastname: Gutti
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Walter
authors.initials: W
authors.lastname: Bosch
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Sasa
authors.initials: S
authors.lastname: Mutic
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Eric
authors.initials: E
authors.lastname: Ford
authors.affiliation: Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Terezakis
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: lsantanam@radonc.wustl.edu.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Santanam
mesh_terms: D016208:Databases, Factual; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D061214:Patient Safety; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D018787:Radiation Oncology / Q000592:standards*; D011878:Radiotherapy / Q000592:standards*; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012308:Risk Management / Q000379:methods