SU‐E‐T‐236: Checklists — A Powerful Error Mitigation Tool in Radiation Therapy

Abstract

Purpose: In our clinic, we treat a variety of patients with external beam radiation therapy, linac‐based SRS, SBRT and Brachytherapy — HDR and LDR. With limited resources and being a learning and teaching environment, we have implemented checklists at several steps in the clinic in order to reduce errors and also as a tool to guide new staff to get oriented to the clinic specific processes in a quick and efficient way. To portray the importance and significance of use of checklists as a powerful tool in mitigating errors in radiation therapy clinics. Also, checklists provide robust means of bringing new staff on‐board and cross‐training. Methods: The initial work of creating checklists for a process requires a clear and deep understanding of the process, significant steps/items, most commonly missed steps/items and their impact on patient care, safety and quality. Checklists have to be created with patient care, comfort and quality in mind. After creating checklists, they have to be critically scrutinized and constantly evaluated and updated during the initial testing phase before it can be standardized in the clinic. Results: In our clinic, we were able to implement checklists for several processes such as frame‐based SRS treatments, frame‐less SRS treatments, SBRT treatments, LDR Pre‐implant checklist, LDR post‐implant checklist, HDR treatments, HDR weekly chart checks and billing. Implementing checklists required physicist time and several iterations of critical review and modifications before standardization. Billing issues were resolved and there were fewer charges missed. Errors such as identifying the appropriate cones before treatments, completion of appropriate chart checks, documents and approvals before treatment were all resolved which resulted in smooth operation during patient treatment. Conclusion: Implementing checklists helped us streamline the processes and eliminate some of the common errors in daily operation. Both HDR and stereotactic services benefitted most from implementing checklists.