Optimizing Safety in a Radiation Oncology Department Through Improving Timeliness of Treatment Planning Care Path

Abstract

The process of radiation treatment planning is a critical component in the overall quality of radiation treatment. Inherent to patient safety is a stream-lined treatment planning workflow that allows all stake-holders an adequate amount of time to complete treatment planning tasks. At our multi-site academic radiation oncology program, overdue treatment planning tasks resulted in rushed dosimetry, physics, and therapist plan checks. The purpose of this study was to evaluate the existing treatment planning workflows, develop adequate timelines for each team member based on planning complexity, create hard stops at each point of hand off within treatment planning, and develop a method for tracking specific timeliness to improve quality and safety.Data was collected on the percentage of overdue contours and plan approvals, which were tasks assigned to radiation oncologists within the facility's patient information system. Previous treatment planning workflows were 5 days or less. The time allotment for each physician, dosimetry, physics, and therapist group to complete their assigned tasks was changed based on creating an optimized workflow with designated workflows for 5-, 7- and 10-day time periods from simulation to treatment start. Workflows were created in the patient information system to reflect these changes. A "hard stop" was implemented such that a patient's start date was rescheduled if a task was not completed within 2 hours of its due date. The data was then collected on total number of overdue contours and plan approvals after this new workflow was introduced.From 2018-2019 with the previous 5-day workflows, data was collected on a total of 1051 patients. The average number of overdue treatment planning tasks per month was 39.4% of physician contours and 41.3% of physician plan approvals. An optimized workflow with 5, 7 and 10 days was introduced in November 2020. For the first 3 months of this new workflow, data was captured on 512 patients. The data reflected improvement of timeliness with only 21% of contours and plan approvals overdue during this time.An optimized workflow utilizing the patient information system and delaying treatment starts, if tasks are overdue, has significantly reduced the team burden of overdue tasks within a multi-site academic radiation oncology center. This workflow could be easily applied to other centers and is a cost-effective approach to improving patient safety and workflow efficiency.