title: National study to determine the comfort levels of radiation therapists and medical dosimetrists to report errors.
abstract: OBJECTIVE
  Better understanding of the error reporting culture in radiation oncology treatment facilities, and obstacles to reporting, can provide insight into potential areas for improvement. We conducted a survey of radiation therapists and dosimetrists to examine the error reporting cultures in radiation oncology facilities across the United States and staff comfort in reporting errors.
  
  
  METHODS
  In 2011, a national sample of 1500 radiation therapists and 528 dosimetrists was mailed a 27-item survey assessing perceptions regarding communication among staff, comfort in error reporting, and associated obstacles. Survey results were summarized using descriptive statistics, and factors associated with discomfort with error reporting analyzed using multivariate logistic regression.
  
  
  RESULTS
  A total of 356 radiation therapists from 47 states (24% response rate) and 190 dosimetrists from 35 states (36% response rate) responded to the survey. Almost all (87% of therapists and 88% of dosimetrists) reported that there is an error reporting system in their treatment facility. Most feel that communication between them and physicians and dosimetrists or physicists (81% and 88% of therapists, and 89% and 88% of dosimetrists, respectively) is good, but only 65% of therapists and 66% of dosimetrists agree that communication with administrators is good. Obstacles to reporting errors included hierarchy within the treatment facility, poor communication, and fear of reprimand. On multivariate analysis, previous personal reprimand for reporting errors (odds ratio, 4.13, P = .001) and reprimand of other therapists and dosimetrists (odds ratio, 2.55, P = .03) were significantly associated with discomfort in error reporting.
  
  
  CONCLUSIONS
  The majority of therapists and dosimetrists feel communication in their treatment facilities is good and that there are systems in place to report errors. A sizable minority reported experience with reprimand for error reporting that significantly reduced their comfort level with reporting errors. Obstacles identified in this study represent opportunities for future research and potential ways for improvement in radiation oncology treatment facilities.
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Church
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: robert_adams@med.unc.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Adams
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Hendrix
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Holmes
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen