PD-0867 Development of a Radiotherapy Quality Assessment Tool

Abstract

Purpose or Objective There is increasing focus on developing and implementing quality and service improvement methodology in healthcare practice with it recognised that these principles must be embedded in the governance framework and culture of services. Radiotherapy (RT) pathways are complex and multidisciplinary. This project aims to develop a quality assessment (QA) tool for evaluating operational/technical aspects of RT service within and across different departments. Materials and Methods A multidisciplinary team (MDT) scoping exercise was undertaken within a single large RT centre and theme analysis was cross referenced with associated literature and theories to inform the development of the QA tool. The tool was validated in three different clinical scenarios and the associated processes were refined through MDT inquiries. There as 5 steps to completing the tool as a collaborative MDT. 1. Framing the question Questions can be categorised into two categories. Category 1: Direct comparison between the same service/pathway in two different departments. Category 2: Comparison of two alternative pathways in a single department. 2. Identifying drivers Primary and secondary drivers for answering the given question should be discussed and noted to allow for considered evaluation of scoring following completion of the tool 3. Scoping Review of the metrics/measures of quality and efficiency/resource for different aspects of the pathway should be identified under the headings outlined below. - Structure: Consider the attributes of the service/ pathway such as e.g. Staff to patient ratios, Skill Mix/Pay banding - Process: Consider how each procedure/system of work interacts in order to achieve the outcomes as defined by clinical policies and procedures. - Outcome: Measures should consider the impact on potential endpoints. 4. Scoring Each aspects of the pathway identified under the different headings is discussed and scored according to the scoring matrix for both the quality and efficiency/productivity (table 1). Only a quality score is applied to the outcomes. (Table presented.)ale Results) Clinical example 1 (COVID initiative): telephone vs face to face on treatment consultation Completing the QA tool identified not only that there were comparable outcomes with significant efficiency and potential quality improvement via telephone consultation but also highlighted where enhancement of other areas of the patient pathway were needed. This mitigated patient care risk to allow benefits from this service improvement to be realised.) Clinical example 2: Treatment verification for prostate SABR CBCT vs Fiducial Utilising the tool in this clinical example identified key lines of enquiry from both a clinical and technical perspective and promoted an objective evidence-based approach to evaluating the necessities of fiducials in the context of prostate imaged guided radiotherapy. A pathway change was implemented. Clinical example 3: Eclipse pathway vs Pinnacle pathway The tool was implemented following an MDT incident review meeting. Figure1 shows the visual output after completing the tool scoring comparing the two palliative RT pathways utilising two different RT planning systems. Points 1,2 relate to structure, 3,4,5 to process and 6 the outcome. It was evident that despite the outcome of the two pathways being comparable, pathway 2 represented a quality improvement not only in quality including risk but also efficiency features of the pathway and was implemented in practice. $Φg Conclusion The QA tool can support collaborative service improvements and enhance the governance process within RT services. Analysing the themes of user feedback from those who were involved in the piloting of the QA tool indicated that the tool was supportive in, • Objective independent discussion. • Encouraging collaboration between different professions. • Promoting an evidence-based approach across all aspects of the pathway. • Provided a useful output for reporting within governance process. • Future work has been planned to valid te the tool in a multicentre setting. Future work has been planned to validate the tool in a multicentre setting.