Incident Learning During the Early COVID-19 Pandemic

Abstract

Purpose/Objective(s)To assess the impact of the early COVID-19 pandemic on incident learning through evaluation of events reported to RO-ILS: Radiation Oncology Incident Learning System®. The Radiation Oncology Healthcare Advisory Council (RO-HAC) hypothesized that the COVID-19 pandemic would impact the engagement of RO-ILS participants in reporting to the patient safety organization (PSO) and that the characteristics of the reported events would differ from those reported pre-COVID.Materials/MethodsThe RO-ILS database was queried for events reported to the PSO pre-COVID (from March 1, 2019 to July 31, 2019) and during early COVID (March 1, 2020 to July 31, 2020). Events were then segregated into those submitted by the Top 5 reporting practices and those practices in early COVID hotspot states as identified by the Centers of Disease Control and Prevention (WA, CA, AZ, TX, FL, NY, NJ, CT, MA, PA, MD). Descriptive statistics were used to describe trends in reporting and differences in data elements provided by the practice and RO-HAC pre-COVID and during-COVID.ResultsThere was a 16% absolute reduction in event reporting during-COVID (n = 1255) as compared to pre-COVID (n = 1759). Practices located in COVID-hotspots had a 33% absolute reduction in reporting, while those not in hotspots had a 23% reduction. However, initial analysis did not identify drastic change in event classification. Amongst the Top 5 reporting practices, there was a 48% absolute reduction in incident reporting; of note, three of these practices did not report any events to the PSO during-COVID. During-COVID, errors more often occurred and were discovered during treatment planning, regardless of hotspot status. RO-HAC independently rated more events as moderate-critical pre-COVID (43%) than during COVID (33%), whereas practices rated more events as moderate-severe during-COVID (25%) than pre COVID (18%). Despite an expected trend towards more hypofractionated regimens, there was neither an appreciable difference in the types of treatment techniques for all events nor magnitude of dosimetric deviations associated with incidents pre-COVID and during-COVID.ConclusionReporting to RO-ILS declined during the early COVID-19 pandemic, especially in hotspot areas. This suggests that resources and time were diverted away from incident reporting to address other critical needs. Three of the five top reporting practices that ceased reporting during early COVID have since reported events after the analysis timeframe, suggesting the decline may be temporary. RO-HAC overall rated events as higher severity than the practice regardless of the pandemic. However, the drop in perceived severity by RO-HAC pre and during-COVID may be the result of changes in clarity of information provided by the practice. Stability in event classification suggests that practices continued to report a variety of events.