The Importance of Standardization in Workflow Enhancement and Patient Safety

Abstract

Continuous quality improvement is a priority of radiation oncology practice given the many complexities in the treatment process. Incident forms (IFs) are completed by caregivers who observe workflow or process flaws. Our workflow enhancement (WE) team reviews IFs related to radiation simulation procedures. A resident led quality improvement project was undertaken to standardize simulation request forms using templates based on common setups for each disease site. We examined IFs collected by our WE team to evaluate if introducing standardized templates resulted in a reduction of incidents. We identified the number of simulations performed in 2015 along with IF reports as recorded by our WE team preceding the implementation of standardized simulation request templates, and then again in 2016 after implementation of standardized templates. IFs were analyzed by type: informed consent (proper documentation or not), treatment setup (e.g., as respiratory management, mask, bolus, contrast, positioning, scan type or length), treatment modality (electrons, fields), treatment site (additional sites or wrong site marked on simulation request form), and miscellaneous (form not signed by physician, medication or scheduling error). A Chi-square analysis was utilized to evaluate for a reduction in reported IFs after implementation of standardized simulation templates. Overall, there were 2224 simulations completed in 2015 and 2241 in 2016. The number of IFs generated regarding simulation processes decreased from 68 in 2015 to 29 in 2016, for a relative decrease of 57% (p<0.0001). The reduction in IFs following utilization of standardized simulation request forms is summarized by type in Table 1 below:Abstract 3324; Table 1Process Related IFs20152016% changeTotal Incident Forms682957%Informed consent9367%Treatment setup331458%Treatment modality5340%Treatment site11645%Miscellaneous10370% Open table in a new tab Introduction of standardized simulation request templates resulted in a 57% reduction in the number of reported IFs. Continuous quality improvement processes can result in fewer errors potentially impacting patient care.