title: Data-driven management using quantitative metric and automatic auditing program (QMAP) improves consistency of radiation oncology processes.
abstract: OBJECTIVE
  Process consistency in planning and delivery of radiation therapy is essential to maintain patient safety and treatment quality and efficiency. Ensuring the timely completion of each critical clinical task is one aspect of process consistency. The purpose of this work is to report our experience in implementing a quantitative metric and automatic auditing program (QMAP) with a goal of improving the timely completion of critical clinical tasks.
  
  
  METHODS
  Based on our clinical electronic medical records system, we developed a software program to automatically capture the completion timestamp of each critical clinical task while providing frequent alerts of potential delinquency. These alerts were directed to designated triage teams within a time window that would offer an opportunity to mitigate the potential for late completion. Since July 2011, 18 metrics were introduced in our clinical workflow. We compared the delinquency rates for 4 selected metrics before the implementation of the metric with the delinquency rate of 2016. One-tailed Student t test was used for statistical analysis RESULTS: With an average of 150 daily patients on treatment at our main campus, the late treatment plan completion rate and late weekly physics check were reduced from 18.2% and 8.9% in 2011 to 4.2% and 0.1% in 2016, respectively (P < .01). The late weekly on-treatment physician visit rate was reduced from 7.2% in 2012 to <1.6% in 2016. The yearly late cone beam computed tomography review rate was reduced from 1.6% in 2011 to <0.1% in 2016.
  
  
  CONCLUSIONS
  QMAP is effective in reducing late completions of critical tasks, which can positively impact treatment quality and patient safety by reducing the potential for errors resulting from distractions, interruptions, and rush in completion of critical tasks.
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: yun@ccf.org.
authors.forename: Naichang
authors.initials: N
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ping
authors.initials: P
authors.lastname: Xia
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mastroianni
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Kolar
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Chao
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: John F
authors.initials: JF
authors.lastname: Greskovich
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
mesh_terms: D057286:Electronic Health Records; D006801:Humans; D061214:Patient Safety; D010820:Physicians; D011785:Quality Assurance, Health Care / Q000379:methods*; D018787:Radiation Oncology / Q000379:methods* / Q000458:organization & administration*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012984:Software; D057188:Workflow