Reducing Treatment Scheduling Errors in a Radiation Therapy Department

Abstract

Aim: Appointment booking in radiation therapy is a highly manual process that cannot be easily automated within Mosaiq. As a result of significant manual data entry required by both the Radiation Therapy and Unit Coordinator teams, our incident reporting data consistently indicates that 1 out of 5 reports related to scheduling and scheduling is the 2nd most common incident type. Our aim is to reduce both frequency and impact of scheduling errors; to reduce the number of errors that reach the patient by 50% and those that do not reach the patient by 25%. We aim to reduce the overall number of scheduling related incidents by 25% and those related to treatment booking by 50%. Process: Data was obtained through our online incident reporting and learning software. Baseline data was collected for a period of 13 months with our first PDSA cycle beginning July, 2021, with a 3-month cycle time. Data was extracted based on the tag and point of origin with 75.3% of the reports originating with the process of appointment booking rather than request for booking. Analysis indicated that 52.6% were related to treatment bookings while 47.4% to simulation/other bookings. Subsequent thematic analysis of treatment booking errors showed 5 common themes: incorrect treatment dates, SBRT fractionation, wrong timeframe for review, review missing, and appointment status/comments incorrect. Processing mapping indicated an opportunity to add an independent quality check earlier in the workflow. A second check was created for the unit coordinators where the above criteria are independently checked within 24 hours after the appointments are initially booked. A fidelity check via QCL to track changes made during this step. Benefits/Challenges: Reducing scheduling errors is beneficial for both patient and staff. Scheduling errors can lead to delay in a patient receiving treatment, additional wait time at the center, decrease in patient experience and increased anxiety. Scheduling errors also contribute to rework and inefficiencies for staff, avoidable idle time of the treatment machines and increased potential for conflict between patient and staff. The primary challenge was in leading change as this project involved engagement not only within the Radiation Therapy team but also within the Unit Coordinator team. We were able to address this challenge by focusing on positive quality culture messaging, education and continued support. Impact/Outcomes: After completing 2 PDSA cycles, there remains opportunity for improvement in reducing the number of incidents that reach the patient; however, a positive trend indicates improvement in 50% of the sub-themes analyzed. Positive correlation was found between the use of the implemented second check and corresponding number of decreased incidents reported by staff. Improvement is also seen in point of origin of errors indicating that fewer errors are originating from the booking process. The project has also provided us the opportunity to recognize additional contributing factors affecting scheduling processes including access to and use of standard operating procedures. We will be harnessing these learning opportunities for continued improvement.