Whiteboard patient tracking system improves radiation oncology treatment planning workflow

Abstract

As care delivery becomes ever more complex, and physicians and health care systems face increasing demands, improved efficiency within radiation oncology departments is essential. The workflow required for quality radiation treatment delivery necessitates detailed communication between multiple specialized team members and emerging technologies, sometimes at different locations. In this study, we compare 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. We retrospectively reviewed dosimetric workflow data from 578 patients treated between January 2015 and January 2017 (320 pre- and 258 post-whiteboard). The whiteboard system cataloged various patient clinical factors as well as workflow metrics. Departmental workflow was then examined and time from simulation date to contour approval, plan approval, and start date of the prescribed therapy were compared. Statistical analyses were performed using Mann-Whitney tests or paired t tests. There was a 17% reduction in the time from simulation to contour approval, 3.0 to 2.5 days, respectively (p = 0.007). There was also a 24% reduction in the time from simulation to plan approval, 6.3 to 4.8 days (p < 0.001). On subset analysis by individual disease site, head and neck cancer as well as lung cancer cases showed statistical improvement in the time from simulation to plan approval. Two of the three physicians evaluated demonstrated a statistical improvement in the time from simulation to plan approval. Physician 1 improved from 6.9 to 5.5 days (p = 0.001) and physician 3 from 8.7 to 8.3 days (p = 0.002). Whiteboard implementation resulted in a significant decrease in time from CT simulation date to contour approval and plan approval. When used effectively, an automated whiteboard system facilitates improved workflow.