Converting a clinical indicator on patient missed treatments into a functional quality improvement metric.

Abstract

101 Background: Extended time to complete a course of radiation can be detrimental to a patient’s overall local tumor control and survival. The American College of Radiology (ACR) Radiation Oncology Practice Guideline requires review of any unplanned interruptions during treatment. However, factors that impact missed treatments are neither required to be reviewed nor well characterized within the literature. We sought to understand the variables contributing to missed treatments by generating a functional metric for quality improvement. Methods: The departmental electronic medical record (EMR) was modified to create sub-sets of classifications for missed treatments. These categories were divided into intended and unintended breaks, with intended classification of physician prescribed break and eight subcategories of unintended breaks: patient preference, physician mandated, patient feels ill, transportation/social services, cancelled, no-show, weather, and machine downtime. Missed treatments were documented real-time by the treating radiation therapists using one of these eight categories. A custom report was generated to extract and separate missed treatments by category. Results: Over three years of ACR tracking, our department missed treatment rate ranged from 5-10%, out of 64,000 patient treatments. The new subcategory metric has been in place for the past six months. Overall compliance with documentation by therapists was 100%. The new metric yielded a six month total rate of missed treatments of 8% with detailed analysis showing the main reasons as: patient preferences (14%), inclement weather (14%), and machine down time (9%). Transportation was only a minor issue for the patient population. Conclusions: This stratification of a simple clinical indicator has identified the major factors influencing the total time to complete a course of treatment. Based on this analysis, our departmental quality committee is focusing on engaging and educating patients about the negative impact of missed treatments on their overall cancer care. Future research will attempt to identify patient characteristics that may predict individuals more likely to miss treatments.