Whiteboard Patient Tracking System Improves Radiation Oncology Treatment Planning Workflow

Abstract

The workflow between CT simulation and treatment delivery requires detailed communication between multiple team members and computer software systems. With increasing clinical demands and multiple facilities, resultant delays may adversely impact patient care. Our goal was to evaluate the clinical impact of a new Whiteboard system to accomplish tasks between CT simulation and treatment delivery. The Whiteboard system allows daily tracking of key steps within the treatment planning workflow, with scheduled periodic automated email reminders for incomplete tasks. We compared the time required for completion of several components of this process, before and after Whiteboard implementation, hypothesizing that Whiteboard usage would decrease the time required to complete the designated task, thereby improving workflow. As a historic control, from 2014 and 2016, our dosimetrists tracked completion dates of key components of the radiation oncology workflow. Pending or incomplete patient contours and plan approval requests were sent to physicians via email by the dosimetrist. Three attending physicians were selected who regularly use and update Whiteboard data for their patients and for whom historic data was available. The Whiteboard was implemented in 2016 and tracked patient data in a customizable database. Daily automated email reminders were sent to the physicians regarding incomplete contours or plans awaiting review. Dosimetrists were notified when patients were simulated, contours were complete, and plans were approved. There were 248 patients in the pre-Whiteboard and 292 in the post-Whiteboard groups, for a total of 540 patients analyzed. The following data were collected for analysis: number of days from CT simulation date to contours approval, simulation date to plan approval, and completed contours to plan approval. Patients with incomplete documentation were excluded. T-tests were used to assess statistical significance. Days from CT simulation to contours approval, simulation to plan approval, and contours to plan approval were assessed. Mean and median intervals are demonstrated in the accompanying table below. In each case, p-values were <0.0001 in favor of Whiteboard implementation.Abstract 3309Mean (SD)MedianSimulation to Contour Approval (d)Before WB3.5 (2.5)3.0After WB2.1 (2.1)1.0CT Simulation to Plan Approval (d)Before WB6.1 (3.4)6.0After WB4.4 (2.8)5.0Contour Approval to Plan Approval (d)Before WB2.7 (3.1)1.0After WB1.6 (1.9)1.0 Open table in a new tab Whiteboard implementation resulted in a significant decrease in time from CT simulation date to contours approval, simulation date to plan approval, and contours to plan approval. When used effectively, an automated Whiteboard system facilitates improved workflow.