An Easy and Creative Fix to Upgrade any Hospital's Existing Protected Incident Reporting System to More Specifically Address Radiation Oncology Department Issues, Increase Transparency within the Organization, and Drive Local Quality Improvement

Abstract

Hospital incident reporting systems offer in-house transparency and legal protection but do not contain fields specific enough to easily track radiation-oncology near-miss event-data for performance improvement (PI) projects. National databases have been created with more specific fields, however not all hospitals approve use of a national database; and department-specific process-related issues may not have nation-wide relevance. Creation of independent systems within radiation oncology (RO) departments is tempting from a data control perspective, but can be cumbersome to build and manage, and may create transparency and legal concerns for the institution. To address these issues, we hypothesized that there must be a way to work with our Integrated Risk Management department to enhance our hospital’s existing protected incident reporting system to more specifically address RO department issues, increase transparency within the organization, and drive local quality improvement. We reviewed the field options of the existing hospital incident reporting database, specifically those categorizing event types, and decided that within the text box associated with the Safety Category “Radiology & Radiotherapies - Other (Please Specify),” we would simply ask for entry of a numerical value to correlate with a standardized list we have posted throughout the department (and provided to the Office of Integrated Risk Management). This list contains (<40) categories of near-miss incidents we wish as a department to follow. Pertinent details of the specific events are entered in a separate text box to help us clarify issues and plan PI projects. By pre-selecting categories, we can report events in a consistent manner that can easily be utilized to track and trend gaps in our processes. Intra-departmental team leaders and hospital risk management leadership agreed on this simple innovative approach. Although it is a bit more cumbersome for hospital administration to “de-code” the RO department issues, the ease of data entry and increased ability of sorting for focusing and following RO department quality and PI efforts makes this a win-win. No modifications to the existing software were necessary. With a common goal of encouraging reporting in a safe environment with transparency and support of local quality and PI projects, RO department and hospital leadership can work together to create a standardized menu of RO department specific patient safety and performance categories to track within the existing protected hospital incident reporting system. A simple numerical system may be created to speed entry in the existing online hospital database and ease data management for tracking and reporting purposes. We would still recommend working with your local hospital risk management team to support entry in a national database of unusual incidents and those of potential broader relevance outside of unique department processes.