An automated electronic system for managing radiation treatment plan peer review reduces missed reviews at a large, high-volume academic center

2016 ◽  
Vol 6 (6) ◽  
pp. e307-e314 ◽  
Author(s):  
Peter E. Gabriel ◽  
Kristina D. Woodhouse ◽  
Alexander Lin ◽  
Jarod C. Finlay ◽  
Richard B. Young ◽  
...  
Keyword(s):  
Peer Review ◽  
Radiation Treatment ◽  
Treatment Plan ◽  
High Volume ◽  
Electronic System ◽  
Academic Center

scholarly journals Journey Toward High Reliability: A Comprehensive Safety Program to Improve Quality of Care and Safety Culture in a Large, Multisite Radiation Oncology Department

2016 ◽  
Vol 12 (5) ◽  
pp. e603-e612 ◽  
Author(s):  
Kristina Demas Woodhouse ◽  
Edna Volz ◽  
Amit Maity ◽  
Peter E. Gabriel ◽  
Timothy D. Solberg ◽  
...  
Keyword(s):  
Control Chart ◽  
Safety Culture ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
High Reliability ◽  
Electronic System ◽  
Healthcare Research ◽  
University Of Pennsylvania ◽  
Safety Issues ◽  
Academic Center

Background: High-reliability organizations (HROs) focus on continuous identification and improvement of safety issues. We sought to advance a large, multisite radiation oncology department toward high reliability through the implementation of a comprehensive safety culture (SC) program at the University of Pennsylvania Department of Radiation Oncology. Methods: In 2011, with guidance from safety literature and experts in HROs, we designed an SC framework to reduce radiation errors. All state-reported medical events (SRMEs) from 2009 to 2016 were retrospectively reviewed and plotted on a control chart. Changes in SC grade were assessed using the Agency for Healthcare Research and Quality Hospital Survey. Outcomes measured included the number of radiation treatment fractions and days between SRMEs, as well as SC grade. Results: Multifaceted safety initiatives were implemented at our main academic center and across all network sites. Postintervention results demonstrate increased staff fundamental safety knowledge, enhanced peer review with an electronic system, and special cause variation of SRMEs on control chart analysis. From 2009 to 2016, the number of days and fractions between SRMEs significantly increased, from a mean of 174 to 541 days (P < .0075) and 21,678 to 113,104 fractions (P < .0028) preintervention and postintervention, respectively. Agency for Healthcare Research and Quality results demonstrate a high patient SC grade over time. Conclusion: Our journey toward becoming an HRO has led to the development of a robust SC through a comprehensive safety framework. Our multifaceted initiatives, focusing on culture and system changes, can be successfully implemented in a large academic radiation oncology department to yield measurable improvements in SC and outcomes.

Implementation of Peer Review Quality Rounds for Gynecologic Brachytherapy an a High-Volume Academic Center

Brachytherapy ◽  
2018 ◽  
Vol 17 (4) ◽  
pp. S108-S109
Author(s):  
Minh-Phuong Huynh-Le ◽  
Derek Brown ◽  
John Einck ◽  
Loren Mell ◽  
Arno J. Mundt ◽  
...  
Keyword(s):  
Peer Review ◽  
High Volume ◽  
Academic Center

A peer review quality assurance program for outpatient radiation treatments.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 13-13
Author(s):  
Matthew T. Ballo ◽  
Gregory Chronowski ◽  
Pamela Schlembach ◽  
Elizabeth S. Bloom ◽  
Isidora Arzu ◽  
...  
Keyword(s):  
Peer Review ◽  
Radiation Treatment ◽  
Peer Review Process ◽  
Treatment Plan ◽  
Quality Assurance Program ◽  
Treatment Change ◽  
Disease Site ◽  
Radiation Treatments ◽  
Changes Over Time ◽  
Over Time

13 Background: Our outpatient radiation treatment centers implemented a peer review program in 2007 that required presentation of all definitive cases to a weekly peer review conference. The purpose of this review is to document compliance and determine how this program impacted care over 4 years. Methods: Between 9/2007 and 9/2011, 2,988 patients were eligible for peer review. Patient data was presented to a group of physicians, physicists, and dosimetrists via teleconferencing and the radiotherapy plan was reviewed. Details of any changes made to patient care were documented within a QA note dictated after discussion. Any changes recommended by the peer review process were categorized as changes to radiation dose, target, or major changes. Results: Breast cancer accounted for 47.9% of all cases, followed in frequency by H/N (14.8%), GI (9.9%), GU (9.3%), and thoracic (6.7%) malignancies. Of the 2,988 eligible patients, 158 (5.3%) were not presented for peer review. The number of missed presentations decreased over time; 2007-8.2%; 2008-5.7%; 2009-3.8%; and 2010-2.7% (p<0.001). The reason for a missed presentation was unknown, but varied by disease site and physician. Of the 2,830 cases presented for peer review, a change was recommended in 346 cases (12.2%) and categorized as a dose change in 28.3%, a target change in 69.1% and a major treatment change in 2.6%. When examined by year of treatment the number of changes recommended decreased over time: 2007-16.5%; 2008-11.5%; 2009-12.5%; and 2010-7.8% (p<0.001). The number of changes recommended varied by disease site and physician. H/N, GYN, and GI malignancies accounted for the majority of changes made. Conclusions: Compliance with this weekly peer review QA program was satisfactory and improved significantly over the 4 year study period. The QA program resulted in decreased treatment plan changes over time reflecting a move toward radiation treatment consensus and consistency. Weekly peer review directly improved care in all patients by creating a culture of QA where guideline adherence and discussion are part of normal practice.

scholarly journals Implementation of peer-review quality rounds for gynecologic brachytherapy in a high-volume academic center

Brachytherapy ◽  
2020 ◽  
Vol 19 (6) ◽  
pp. 881-888 ◽  
Author(s):  
Minh-Phuong Huynh-Le ◽  
Aaron B. Simon ◽  
David J. Hoopes ◽  
John P. Einck ◽  
Catheryn M. Yashar ◽  
...  
Keyword(s):  
Peer Review ◽  
High Volume ◽  
Academic Center

A radiation oncology peer review program for community hospitals.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 200-200
Author(s):  
Laurie Sturdevant ◽  
Wendi Martinez ◽  
Nikhil Thaker ◽  
Anuja Jhingran ◽  
Deborah A. Kuban
Keyword(s):  
Peer Review ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Peer Review Process ◽  
Community Setting ◽  
High Volume ◽  
Integrated Approach ◽  
Cancer Center ◽  
National Guidelines ◽  
Md Anderson

200 Background: Certified Members within the MD Anderson Cancer Network must perform prospective internal review of radiation oncology cases treated at their institution. Since 2009, several Network sites have been systematically added to a quality oversight program. As part of this process, a sample of the internally peer reviewed cases are assessed by radiation oncology Faculty from MD Anderson Cancer Center (MDACC) who are considered disease site experts. Methods: An electronic tool was used by Network sites to enter clinical treatment information on patients undergoing peer review. This case log was used to select a sample size of not less than 10% of each physician’s case load for an in-depth quarterly evaluation by our Faculty. Quality and appropriateness metrics included review of the technical components of the radiation treatment (RT) plan and multidisciplinary management.. RT was scored as being concordant/non-concordant with MDACC or national guidelines. Non-concordant cases were further reviewed for appropriateness given the individualized case. Feedback was then provided by Faculty to the treating radiation oncologists quarterly, to discuss recommendations and practice pattern modifications. Results: To date, 6 of our 13 Network sites are participating in this peer review process with others being phased in. In 2013, we selected 104 of 719 cases entered into our database by the first four sites. 78% (81) of cases were concordant with guidelines, while 22% (23) were non-concordant. Of the non-concordant cases, 23% were deemed individually appropriate but the remainders (17 of 104) were not appropriate. Concordance in the most frequent disease sites ranged from 80 to 89%. In the less frequent disease sites concordance was lower, ranging from 50 to 73%. Conclusions: The highly technical aspects of radiation treatment, the frequent need to integrate a multidisciplinary approach, and the reality that low volume disease sites will need to be increasingly treated in the community accentuate the need for enhanced oversight and more effective consultation with high volume, expert providers. Our study suggests that an integrated approach to peer review can improve the quality and value of cancer therapy in the community setting.

scholarly journals Secondary care interface: optimising communication between teams within secondary care to improve the rehabilitation journey for older people

2021 ◽  
Vol 10 (1) ◽  
pp. e001274
Author(s):  
Sean Testrow ◽  
Ryan McGovern ◽  
Vicki Tully
Keyword(s):  
Information Sharing ◽  
Secondary Care ◽  
Royal Victoria Hospital ◽  
Treatment Plan ◽  
Electronic System ◽  
The Elderly ◽  
Communication Tool ◽  
Clinical Communication ◽  
Transfer Of Information ◽  
Intervention Clinic

Effective communication between members of the multidisciplinary team is imperative for patient safety. Within the Medicine for the Elderly wards at Royal Victoria Hospital (RVH) in Dundee, we identified an inefficient process of information-sharing between the orthopaedics outpatient department (OPD) at the main teaching hospital and our hospital’s rehabilitation teams, and sought to improve this by introducing several changes to the work system. Our aim was for all patients who attended the OPD clinic to have a plan communicated to the RVH team within 24 hours.Before our intervention, clinic letters containing important instructions for ongoing rehabilitation were dictated by the OPD team, transcribed and uploaded to an electronic system before the RVH team could access them. We analysed clinic attendances over a 4-week period and found that it took 15 days on average for letters to be shared with the RVH teams. We worked with both teams to develop a clinical communication tool and new processes, aiming to expedite the sharing of key information. Patients attended the OPD with this form, the clinician completed it at the time of their appointment and the form returned with the patient to RVH on the same day.We completed multiple Plan–Do–Study–Act cycles; before our project was curtailed by the COVID-19 pandemic. During our study period, seven patients attended the OPD with a form, with all seven returning to RVH with a completed treatment plan documented by the OPD clinician. This allowed rehabilitation teams to have access to clinic instructions generated by orthopaedic surgeons almost immediately after a patient attended the clinic, essentially eliminating the delay in information-sharing.The introduction of a simple communication tool and processes to ensure reliable transfer of information can expedite information-sharing between secondary care teams and can potentially reduce delays in rehabilitation.

scholarly journals Outcomes of Peer Review for Radiotherapy Treatment Plans With Palliative Intent

2018 ◽  
Vol 14 (12) ◽  
pp. e794-e800
Author(s):  
Dina Thompson ◽  
Kimberly Cox ◽  
James Loudon ◽  
Ivan Yeung ◽  
Woodrow Wells
Keyword(s):  
Peer Review ◽  
Treatment Plan ◽  
Palliative Radiotherapy ◽  
Cancer Center ◽  
Palliative Intent ◽  
Treatment Plans ◽  
Important Quality ◽  
Radiation Medicine ◽  
Radiotherapy Treatment

Purpose: Peer review of a proposed treatment plan is increasingly recognized as an important quality activity in radiation medicine. Although peer review has been emphasized in the curative setting, applying peer review for treatment plans that have palliative intent is receiving increased attention. This study reports peer review outcomes for a regional cancer center that applied routine interprofessional peer review as a standard practice for palliative radiotherapy. Methods and Materials: Peer review outcomes for palliative radiotherapy plans were recorded prospectively for patients who began radiotherapy between October 1, 2015, and September 30, 2017. Recommended and implemented changes were recorded. The content of detailed discussions was recorded to gain insight into the complexities of palliative treatment plans considered during peer review. Results: Peer review outcomes were reviewed for 1,413 treatment plans with palliative intent. The proportions of detailed discussions and changes recommended were found to be 139 (9.8%) and 29 (2.1%), respectively. The content of detailed discussions and changes recommended was categorized. Major changes represented 75.9% of recommended changes, of which 84.2% were implemented clinically. Conclusion: Many complexities exist that are specific to palliative radiotherapy. Interprofessional peer review provides a forum for these complexities to be openly discussed and is an important activity to optimize the quality of care for patients with treatment plans that have palliative intent.

Precision Jetting of Solder Paste – A Versatile Tool for Small Volume Production

2014 ◽  
Vol 2014 (1) ◽  
pp. 000438-000443 ◽  
Author(s):  
K.-F. Becker ◽  
M. Koch ◽  
S. Voges ◽  
T. Thomas ◽  
M. Fliess ◽  
...  
Keyword(s):  
Process Development ◽  
Droplet Diameter ◽  
Rheological Behaviour ◽  
High Volume ◽  
Electronic System ◽  
High Viscosity ◽  
Solder Paste ◽  
Process Data ◽  
Current Standard ◽  
Conductive Adhesives

During the last years, jetting processes for higher viscosity materials have gained widespread interest in microelectronics manufacturing. Main reasons for this interest are high throughput/productivity of jetting, contactless material deposition, high volume precision and freely designable deposition patterns. In previous studies [i,ii] we have demonstrated the jetability of different resin-based materials, being exemplary for unfilled adhesive, for low viscous Underfill resin and for higher viscosity Glob Top materials. The focus of our previous work was on the dosing of various encapsulants - Underfill material with low viscosity and near Newtonian behaviour and Glob Top resins, being non-Newtonian fluids due to higher matrix viscosity and higher filler content (up to 70 wt %) with resulting increased filer/filler and filler/matrix interaction. During the last years jetting has become widely used and has been applied to the dosing of much more complex materials, combining high viscosity matrix materials with odd shaped and compressive particles. Examples for these materials are conductive adhesives and also solder pastes, where the jetting system developed by Swedish company Mydata set's the current standard for solder paste jetting. In a technological study solder paste jetting using different jetting systems has been investigated in comparison to solder paste dispensing and solder paste printing, especially material rheological behaviour and the correspondence to processability have been evaluated in detail. To illustrate the potential of solder paste jetting as a flexible and powerful tool for electronic system prototyping, a test vehicle has been designed, containing areas for SMD soldering and for process reproducibility. To determine process quality not only basic process data on droplet diameter, resulting material depot size and positioning accuracy have been evaluated, but also statistical means have been employed to determine process homogeneity and stability depending on the respective parameter set. Summarized this paper gives an insight into solder jet process development and describes material rheology demands and limitations and thus allows the optimized use of advanced solder jetting technology for electronics assemblies.

scholarly journals Regional oncology network between pancreatic centers safeguards waiting times for pancreatoduodenectomy

2019 ◽  
Vol 71 (4) ◽  
pp. 645-651 ◽  
Author(s):  
M. Willemijn Steen ◽  
◽  
Claire van Vliet ◽  
Sebastiaan Festen ◽  
Marc G. Besselink ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Postoperative Morbidity ◽  
Waiting Times ◽  
Neoadjuvant Treatment ◽  
High Volume ◽  
Morbidity Rate ◽  
Time To Surgery ◽  
Academic Center ◽  
Periampullary Neoplasms ◽  
Annual Volume

Abstract Pancreatoduodenectomy (PD) is increasingly performed in high-volume centers, which may compromise waiting times. The aim of this study was to evaluate patient flow and outcome of PD within a regional oncology network of two high-volume centers. A post hoc analysis of a partially retrospective and prospective database was performed of all patients who underwent PD for pancreatic or periampullary neoplasms in both centers of the Gastrointestinal Oncology Center Amsterdam, a collaboration between an academic center and affiliated general teaching hospital, from 2010 to 2014. Outcomes included waiting time to surgery and postoperative morbidity and mortality. A total of 525 PDs were performed, 329 in the academic center (annual volume 66) and 196 in the teaching hospital (annual volume 39). Neoadjuvant treatment was more often used in the academic center, other baseline characteristics were similar. Overall time to surgery was 26 days, which was significantly less in the teaching hospital. The major postoperative morbidity rate was 38.3% (n = 201), and the 30- and 90-day mortality was 2.3% and 3.6%. A regional oncology network between an academic center and a general teaching hospital for PD can be an attractive option to safeguard waiting times in selected patients, without compromising outcome.

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