On Treatment Consultations – a Method to Increase Communication within the Radiation Therapy Department

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Staff completed the hospital biennial employee engagement survey which evaluated satisfaction with various components at the organization and departmental level. Radiation treatment (RT) results were disseminated in fall 2016 and a working group was tasked with making improvements. Team discussions identified the need for improved communication and role clarity among the multidisciplinary team with respect to trouble shooting difficult setups or image matching discrepancies. It was also noted that standardization of process and documentation could reduce confusion and conflict. After brainstorming with staff, the idea was created to complete On Treatment Consultations (OTC) within the department. OTC allow a multidisciplinary team to address, investigate and resolve issues and/or queries about plans that are about to start or have started treatment. Examples include: body contour changes, target volume changes, image matching concerns, etc. The process indicates that anyone involved in the patient’s care can initiate interdisciplinary OTC and the OTC are led by a Radiation Therapist. An in-person meeting is scheduled immediately or at a later time, depending on urgency. The necessary individuals (Radiation Therapists, Radiation Oncologists, Medical Physicists, etc. as needed) are brought together to investigate the concern and a decision is made for a plan going forward. OTC can be re-opened later in treatment if needed. OTC were implemented in March 2018 and these consults have resulted in plan modifications and re-plans of treatment cases. Radiation Therapists now have a forum to express their concerns, share their expertise with and learn from other members of the health care team to co-create management plans for challenging cases. One challenge of the OTC process has been in determining an efficient way to coordinate the multidisciplinary discussions. Our perception from staff is that since the implementation of OTC, communication has been more clear and consistent. Difficult setups are discussed more openly and directions resulting from OTC are documented in a more organized manner. The employee engagement survey was completed again in September 2018 and the results will be shared with departments in the spring of 2019. It is hoped that this process change will translate into improved departmental engagement scores.