Improving the Quality of Patient Data Capture in Breast Radiotherapy Peer-Review

Abstract

The importance of multidisciplinary peer-review rounds is widely recognized. Peer-review rounds ensure the quality and safety of individual radiation therapy (RT) treatment plans. At our institution, breast cancer RT peer-review rounds are conducted weekly over 1-hour session, with attendance from radiation oncology, therapy, physics staff and trainees. All newly diagnosed breast cancer patients undergoing radical RT are scheduled for peer-review approximately 1 week prior to their treatment start date. One challenge in conducting peer-review for a large disease site is the ability to systematically review all patients within the limited time constraints. Our objective is to develop a comprehensive patient list with essential patient, tumour, and treatment factors for peer-review and to evaluate its feasibility. A standardized list of patient information essential for peer-review were identified by the site group. The core patient clinicopathologic parameters were entered into the RT Electronic Medical Record (RT-EMR) by the clinician at the time of radiotherapy prescription. Patient information included: age, clinical/pathological stage, surgery type, chemotherapy sequence, tumour size, histology, tumour grade, lympho-vascular invasion, margin status, nodal positivity, ER, PR, and HER2 status, and a comment section. Aside from tumour size, margins, nodal status and comments, all data inputs used dropdown menus, which ensured data consistency and reduced free-text entries. Standard RT prescription selections were templated in accordance with our institutional practice guidelines to facilitate uniformity. All patient parameters extracted from the RT-EMR were transferred to a spreadsheet and evaluated for completeness by a Clinical Specialist Radiation Therapist (CSRT) prior to rounds. For patients with insufficient data for peer-review, missing data were retrieved manually and entered by the CSRT through review of dictated clinic notes. The rate of completion and time required to retrieve missing information were captured following the implementation of the automated data extraction process. RT-EMR data were collected over 40 weeks between April 2015-April 2016. The average patient data completion during the first month of implementation was 64% (SD10) and increased significantly over time to 86% (SD4) in the final month (p<0.001). The time required to ensure data completion was inversely correlated with the overall data completion rate (Pearson r=-0.702;p<0.001). An average of 18 (SD4) patients were peer-reviewed weekly in rounds. The standardization of RT prescription selection and clinicopathologic data streamlined the peer-review process in rounds and significantly decreased preparatory time; mean reduction from 2hr:40mins (first month) to 1hr:15mins in the final month (p=0.005). The standardization and consistent entry of patient’s clinical-pathology data decreased time required for review of transcribed notes for missing patient information. The use of a comprehensive peer-review list is feasible and supports peer-review of all radical breast RT plans, even in the absence of the attending radiation oncologist. Direct entry of patient information at the time of RT decision-making enhances efficiency and allows prospective data capture, reduction of human resources, and avoidance of manually reviewing transcribed clinical notes.