Use of a Novel Process Map and Dashboard to Understand Drivers of Treatment Chart Turnaround Time in a Large Academic Radiation Oncology Practice

Abstract

<h3>Purpose/Objective(s)</h3> Timely delivery of radiation treatment charts is critical to the safe and effective care of patients. Understanding the drivers of treatment chart turnaround time is required to ensure consistency and identify opportunities for improvement. Therefore, we sought to create a novel process map and dashboard for analysis and visualization of the treatment planning intervals that comprise turnaround time. <h3>Materials/Methods</h3> A comprehensive process map of treatment chart flow from simulation to image fusion, tumor volume contouring, treatment planning, physics check (QA), and therapist chart check was created by a team of physicians, radiation therapists, dosimetrists, physicists, and data analysts. Standardized interval definitions were developed to describe the time between unique steps in the planning process, and matched with corresponding quality check list items in the radiation oncology EMR. Time intervals between process steps were calculated for all treatment charts in the system in an automated and continuous fashion. A Tableau dashboard was created to analyze and display the data, allowing for analysis by treatment planning technique, disease site, attending physician, and department site. Results were verified by serial manual comparison of Tableau data with EMR data, repeated over five datasets until the dashboard algorithm successfully matched the data in the EMR. The resulting data were analyzed to identify median turnaround time (mTAT) from Simulation to Therapist Chart Check. To assess the incidence of late charts, a definition of "on time" treatment chart delivery was created for normal charts (excluding same-day and next-day treatments), defined as delivery of the chart at least 4 business hours prior to scheduled treatment start. The percentage of "on time" treatment charts was calculated and compared with a predefined institutional goal of 95%. <h3>Results</h3> A total of 3666 charts were included from 1 Jun 2021 to 1 Feb 2022, with data from 45 physicians across 10 department sites. The mTAT for all treatment charts was 4.80 business days. mTAT increased with increasing complexity of treatment planning and with certain disease sites (see table). Tumor volume completion time consumed the greatest proportion of overall turnaround time, at a median of 1.06 days for all charts and a median of 2.05 days and 2.29 days for IMRT and SBRT charts, respectively. About 93% (3018/3242) of normal charts were delivered "on time", which fell short of the predefined institutional goal of 95%. <h3>Conclusion</h3> The novel process map and dashboard accurately captured and calculated treatment planning intervals from EMR data and provided a platform to analyze and visualize drivers of mTAT and "on-time" chart delivery. This analysis identified contouring time as a key area of opportunity in reducing mTAT.