Patient Safety

PV QA 3 - Poster Viewing Q&A 3

TU_28_3092 - Creation of an Electronic Task Workflow for Timely Chart Review

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Creation of an Electronic Task Workflow for Timely Chart Review
R. van Dams1, P. J. Beron1, N. Agazaryan1, A. Mikaeilian1, P. A. Kupelian1, M. Cao1, S. E. Tenn1, M. L. Steinberg2, and A. U. Kishan1; 1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 2University of California, Los Angeles, Los Angeles, CA

Purpose/Objective(s): The use of chart rounds remains a unique and powerful strategy within the field of radiation oncology for peer review and quality assurance. Extremely hypo-fractionated courses of radiation, including stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), are especially important targets for timely review, as entire courses of treatment may be completed within a week of initiation. The increasing ubiquity of electronic medical records and electronic treatment planning has created an opportunity for transitioning from retrospective peer review of treatment plans toward prospective chart rounds, where treatment plans are reviewed prior to or soon after the first fraction is delivered. We sought to determine the efficacy of a new electronic task workflow for implementing timely chart review.

Materials/Methods: A new process workflow was implemented at a single institution across two sites. This process involved electronic flagging of newly approved treatment plans. This creates a task within our treatment planning software, which is then queued for completion at weekly chart rounds divided between two sessions. This process allows for individual patient-level auditing of task creation and completion. Chart rounds for external beam plans were audited for a 15 week period from October 2017 to February 2018. Plans were classified as fractionated (>5 fractions), SBRT, or SRS cases. Timely review of a chart was defined as presentation at chart rounds prior to start or within two treatment days of the first fraction delivered.

Results: Over the period audited, a total of 423 external beam plans were reviewed. Of those, 322 were fractionated, 80 were SBRT, and 21 were SRS cases. Among the fractionated cases, 276/322 (85.7%) were reviewed in a timely fashion (i.e. prior to start of treatment or within two treatment days). There was a similar proportion of timely reviews among the SBRT plans, at 64/80 cases (80%). All SRS cases, 21/21 (100%), underwent peer review prior to treatment.

Conclusion: Implementation of an electronic task workflow for identification and creation of a centralized queue for all plans requiring peer review has allowed for timely review of a majority of treatment plans delivered at a large academic institution across multiple sites. Notably, rates of timely review were high for both fractionated and extremely hypo-fractionated treatment plans, allowing for appropriate peer review prior to the majority of dose being delivered. With rising adoption of SBRT and SRS, timely review early in the course of a treatment plan will play an increasingly important role in quality assurance. Implementation of these electronic task workflows represents a flexible strategy for improving timely review across a diverse range of practice settings.

Author Disclosure: R. van Dams: None. P.J. Beron: Consultant; Consultant or expert witness. Partnership; Rotating Gamma System of Orange County. N. Agazaryan: Honoraria; Brainlab. Consultant; Brainlab. Travel Expenses; Brainlab. Chapter President; AAPM-SCC. A. Mikaeilian: None. P.A. Kupelian: Research Grant; Varian Medical Systems, Inc. Honoraria; Accuray. Consultant; ViewRay. Advisory Board; Accuray, ViewRay. Travel Expenses; Accuray, ViewRay. M. Cao: None. S.E. Tenn: None. M.L. Steinberg: Honoraria; Accuray.

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