title: Redesign of process map to increase efficiency: Reducing procedure time in cervical cancer brachytherapy.
abstract: OBJECTIVE
  To increase intraprocedural efficiency in the use of clinical resources and to decrease planning time for cervical cancer brachytherapy treatments through redesign of the procedure's process map.
  
  
  METHODS
  A multidisciplinary team identified all tasks and associated resources involved in cervical cancer brachytherapy in our institution and arranged them in a process map. A redesign of the treatment planning component of the process map was conducted with the goal of minimizing planning time. Planning time was measured on 20 consecutive insertions, of which 10 were performed with standard procedures and 10 with the redesigned process map, and results were compared. Statistical significance (p < 0.05) was measured with a two-tailed t test.
  
  
  RESULTS
  Twelve tasks involved in cervical cancer brachytherapy treatments were identified. The process map showed that in standard procedures, the treatment planning tasks were performed sequentially. The process map was redesigned to specify that contouring and some planning tasks are performed concomitantly. Some quality assurance tasks were reorganized to minimize adverse effects of a possible error on procedure time. Test dry runs followed by live implementation confirmed the applicability of the new process map to clinical conditions. A 29% reduction in planning time (p < 0.01) was observed with the introduction of the redesigned process map.
  
  
  CONCLUSIONS
  A process map for cervical cancer brachytherapy was generated. The treatment planning component of the process map was redesigned, resulting in a 29% decrease in planning time and a streamlining of the quality assurance process.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA. Electronic address: adamato@lroc.harvard.edu.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Damato
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Mandar S
authors.initials: MS
authors.lastname: Bhagwat
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Buzurovic
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cormack
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Finucane
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jorgen L
authors.initials: JL
authors.lastname: Hansen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Desmond A
authors.initials: DA
authors.lastname: O'Farrell
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Alecia
authors.initials: A
authors.lastname: Offiong
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Una
authors.initials: U
authors.lastname: Randall
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Scott
authors.initials: S
authors.lastname: Friesen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
keywords: Brachytherapy; Efficiency; Process maps; Workflow