Improving Timely Completion of Radiation Therapy End of Treatment Summaries in a Large Multi-Site Radiation Oncology Department

Abstract

End of Treatment Summaries (EOTs) in radiation oncology are a critical component of communication among the radiation oncologist, care team, and patient. In addition, systematic completion of EOTs is a quality metric among several accrediting bodies in Radiation Oncology. We sought to institute a program to improve the timely completion of EOTs in a large multi-site academic Radiation Oncology department. A pre-post quality improvement study was conducted within our department’s main center and a sample of regional network sites. The aim was to improve the rate of EOTs sent within 15 days of the last day of treatment, which was based on ASTRO Accreditation Program for Excellence (APEx) standards. To quantify the pre-intervention state, baseline data characterizing the time between the end of the radiotherapy course and completion of the EOT was collected over a 6 month period. Qualitative interviews were also conducted to understand perceived barriers to timely completion of EOTs. A multi-tiered intervention was instituted to address these limiting factors. The days elapsed between the end of radiation treatment and EOT completion was subsequently monitored. Differences in the rate of EOTs completed within 15 days before and after our intervention were assessed using the chi-square test. In the baseline and post intervention periods, 1408 and 2500 radiotherapy courses were completed, respectively. Baseline percentages of EOTs completed within 1-15 days, 16-30 days, >30 days, and unsent over the 6 month period was 38%, 12%, 19%, and 31%, respectively. Barriers to timely completion of EOTs included a need for more expedient notification as to when patients complete treatment, a multi-step, inconsistently implemented workflow for creating and sending EOTs, competing clinical obligations, and inadequate physician incentives. Therefore, our intervention consisted of 1) automated notifications to physicians at patient end of treatment, 2) improved pre-population of relevant patient data into the EOT using the electronic medical record, 3) a streamlined EOT workflow with re-education on the EOT completion process for physicians and administrative support, and 4) public reporting of EOT completion rates by individual physician. Following our intervention, percentages of EOTs completed within 1-15 days, 16-30 days, >30 days, and unsent were 64%, 12%, 10%, and 15%, respectively (p<0.001) over the 12 month period. The final average time to completion of the EOT decreased from 27 days pre-intervention to 10 days post-intervention. Using a multimodality approach, we improved both the expediency and total rate of EOT completion in a large multi-site radiation oncology department. Further efforts are needed to demonstrate the durability and enhance the impact of these interventions.