title: Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy.
abstract: OBJECTIVE
  To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents.
  
  
  METHODS
  We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons.
  
  
  RESULTS
  The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents.
  
  
  CONCLUSIONS
  We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: selnaha1@jhmi.edu.
authors.forename: Shereef M
authors.initials: SM
authors.lastname: Elnahal
authors.affiliation: Department of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Amanda
authors.initials: A
authors.lastname: Blackford
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Koren
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Annette N
authors.initials: AN
authors.lastname: Souranis
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Valerie
authors.initials: V
authors.lastname: Briner
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Todd R
authors.initials: TR
authors.lastname: McNutt
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Theodore L
authors.initials: TL
authors.lastname: DeWeese
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Wright
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Terezakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003142:Communication; D016208:Databases, Factual / Q000706:statistics & numerical data; D004282:Documentation / Q000706:statistics & numerical data; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D009369:Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D061214:Patient Safety; D011785:Quality Assurance, Health Care; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects / Q000706:statistics & numerical data; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects* / Q000706:statistics & numerical data; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D012308:Risk Management / Q000145:classification / Q000379:methods / Q000706:statistics & numerical data; D012737:Sex Factors; D047368:Tumor Burden