The Need for Physician Leadership in Creating a Culture of Safety

Abstract

Radiation treatment is generally safe. The reported adverse event rate requiring follow-up care is low: (e.g., z1.2/ 10,000 treated patients; NY State Department of Health estimates [J. Krishnamoorthy, personal communication, August 6, 2010]). Recently however, there is increased interest in patient safety within radiation oncology, prompted, at least in part, by articles in the New York Times (1–4). These articles complement other articles in the lay press (5, 6) and several reports within the radiation oncology literature (7). Taken in concert, these reports implicate the increasing complexity of radiation oncology as a potential source of increased risks for patients (8). Even though radiation therapy is generally safe and efficacious, the potentially devastating effects of misadministrations remind us that we need to be continually vigilant. Subsequent to the NY Times articles, patient safety concerns have been the topic of recent congressional hearings, and meetings sponsored by the Food and Drug Administration (May 2010) and ASTRO/AAPM (June 2010). ASTRO has committed itself to a six-point ‘‘Target Safely’’ action plan (9). The device manufacturers have committed themselves to their own response to the challenge (10). These activities will change the way we practice. There will likely be new standards for clinical practice and training, certification, and recertification of personnel. Quality assurance procedures may be redefined with mandatory time-outs and checklists, and human–computer interfaces will be reengineered to facilitate correct use (11). These initiatives should be applauded and may improve patient safety. Improvements in patient safety will also require us to broaden the scope of our concern. Radiation oncology is a component of an increasingly complicated health care system: We routinely evaluate, treat, and follow patients with