Improving patient safety and workflow efficiency with standardized pretreatment radiation therapist chart reviews.
OBJECTIVE
Radiation therapists play a critical role in ensuring patient safety; however, they are sometimes given insufficient time to perform quality assurance (QA) of a patient's treatment chart and documentation before the start of treatment. In this work, we show the benefits of introducing a formal therapist prestart QA checklist, completed in a quiet space well in advance of treatment, into our workflow.


METHODS
A therapist prestart QA checklist was created by analyzing in-house variance reports and treatment unit delays over 6 months. Therapists were then given dedicated time and workspace to perform their checks within the dosimetry office of our department. The effectiveness of the checklist was quantified by recording the percentage of charts that underwent QA before treatment, the percentage of charts with errors needing intervention, and treatment unit delays during a nearly 2-year period. The frequency and types of errors found by the prestart QA were also recorded.


RESULTS
Through the use of therapist prestart QA, instances of treatment unit delays were reduced by up to a factor of 9 during the first year of the program. At the outset of this new initiative, nearly 40% of charts had errors requiring intervention, with the majority being scheduling related. With upstream workflow changes and automation, this was reduced over the period of a year to about 10%.


CONCLUSIONS
The number of treatment unit delays was dramatically reduced by using a formal therapist prestart QA checklist completed well in advance of treatment. The data collected via the checklist continue to be used for further quality improvement efforts.
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: kyounge@med.umich.edu.
Kelly Cooper
KC
Younge
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
Katherine Woch
KW
Naheedy
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
Joel
J
Wilkinson
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
Joumana
J
Dekmak
Department of Radiation Oncology, University of Alabama, Birmingham, Alabama.
Elizabeth
E
Covington
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
Bonnie
B
Durbin
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
Eric
E
Nelson
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
Stephanie
S
Filpansick
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
Jean M
JM
Moran
D057189:Checklist; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D061214:Patient Safety; D010380:Peer Review / Q000379:methods* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D058996:Quality Improvement; D018787:Radiation Oncology / Q000458:organization & administration / Q000592:standards*; D012015:Reference Standards; D013997:Time Factors; D057188:Workflow