title: Prospective contouring rounds: A novel, high-impact tool for optimizing quality assurance.
abstract: OBJECTIVE
  This study was designed to present the results of a novel prospective contouring rounds (CR), in which peer review occurs once the contours and written directive are completed but before initiation of treatment planning.
  
  
  METHODS
  Beginning in 2012, all patients undergoing conventionally fractionated radiation therapy at a high-volume academic center were reviewed in a newly initiated daily, prospective, multidisciplinary CR. Cases were scheduled for presentation 2 days after simulation with the expectation that contours would be complete. The clinical suitability of the clinical plan, prescription, contours, and written directive were evaluated and recorded in a prospective database. Treatment planning did not commence until CR approval. Patient information and the prospective database from the first 6 months since program inception, which represented 581 consecutive treatment plans, were pooled and analyzed retrospectively to determine the impact of the prospective peer review at this stage of care delivery.
  
  
  RESULTS
  Sixty-four percent of cases were completed on time without correction. The remaining 36% of cases required modification before treatment planning was initiated. Incomplete contours, target-volume modifications, and alterations to the written directive were the most common corrections or reasons for delay. Decreasing rates of incomplete contours, contour modifications, and miscellaneous delays were seen over time as the program became established. The percentage of cases that had no delays or modifications increased continuously as the program matured in the first 6 months, from 59% to 70%.
  
  
  CONCLUSIONS
  Prospective CR is a meaningful and impactful tool in the quality assurance process. More than one-third of cases required contour, directive, or scheduling modification. The establishment of CR improved quality of care, with the percentage of timely, errorless cases increasing steadily over time. The impact of clinical peer review may be optimized by implementation at this early stage of delivery of care rather than at the time of traditional chart rounds.
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York. Electronic address: bcox2@nshs.edu.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Cox
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kapur
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York.
authors.forename: Anurag
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York.
authors.forename: Lucille
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Bloom
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York.
authors.forename: Gina
authors.initials: G
authors.lastname: Goode
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York.
authors.forename: Louis
authors.initials: L
authors.lastname: Potters
mesh_terms: D006801:Humans; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards*